05: The Ozempic Revolution: its about more than weight loss - with McCall

Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness and thyroid, unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. Today, we are talking all things GLP1s experience. You don't know what those are. They are the new revolutionary class of weight loss medication. And let's dig in deep and talk GLP1 agonist. The medical revolution beyond weight loss. And that is the message I want you guys to know. Weight loss is an added bonus to these medications. The benefits that people are getting to their health, to longevity, to healing, to inflammation, become the primary reason for people, especially my patients, utilizing these medications. And the weight loss becomes a secondary byproduct of all of these other benefits. But let's take it back from there. Let's do a quick introduction about how I ended up looking at GLPs, what they mean to me, what they mean to my patients, and build out from there. So for those of you who are unfamiliar, GLP1 weight loss medications are drugs like Wovi, Manjaro, OIC, Zep, Bound, Tirzepatide, Semaglutide. They were initially created as diabetes medications. And 20 or so years ago, when they were treating diabetics with these medications, they started to notice that they were losing a substantial amount of weight. And a couple decades later, now they are FDA approved for weight loss, for obesity, et cetera. What I think people don't understand about this is, you know, number one, these are not new medications. They have been around. We have long term data on these meds because they have been used for diabetes for decades. The other thing I don't think people understand or is misunderstood about these medications is just GLP is a naturally occurring compound in our physiology. GLPs really work to influence our blood sugar levels and our hunger or satiety after we eat. They influence our cravings, they even influence inflammation in our body. And what can happen is these endogenous or natural compounds in our body become less and less effective over time. And that's an important distinguishment in the role of these medications in society. So let's talk about them specifically in the case of weight loss and then we'll build out from there. I think the general public almost views these meds as, oh my gosh, well, everyone's on them, everyone's just lazy. No one wants to do their part. They're people simply need to eat less and exercise more. And I want to Tell you the story about how I ended up getting involved in these medications and becoming so impassioned for them. So, obviously, I'm the founder of Modern Thyroid Clinic. Helping people, but largely women, with their treatment, refractory thyroid conditions has been my life's work professionally, and I do a really good job at it. I am able to give women their lives back. We at Modern Thyroid Clinic are able to give women their lives back, even with the most complex cases of thyroid dysfunction. And there is sort of this timeline of symptoms that improves faster than others. So, like brain fog. Most people's brain fog is gone after their first run of treatment. Energy improves, albeit it's not where it is when it's perfect and their thyroid is completely, you know, balanced. But they get improvement in energy and, you know, their first round of treatment as well. Usually, hair slowly improves, libido slowly improves, Skin, digestion, all of these things. Mood, the last thing, the most painfully slow part of this process is giving a woman or a person with thyroid dysfunction back their ability to appropriately lose weight. And what I mean by that is my practice is actually filled with women who eat really well and they exercise and they pour into their lifestyle, and they do all of the things. It is not wildly uncommon for me to hear things like, well, I've been on the Whole30 diet since 2017, and I still can't lose weight, and I can barely maintain my weight. There is a subset of people in society that are unable to appropriately lose weight with effort, and our society does not recognize these people. And a huge amount of those suffering with a thyroid condition fall into this category. They cannot lose weight with diet and exercise, and society needs to account for these people. And it had been a struggle with me for years to be able to give these people back their ability to lose weight. And you can make a woman feel great. You can give her energy, you can give her joy and motherhood back. But if she does not feel beautiful and like herself in her own skin, you're not there yet. And so, really early on, as these medications were starting to be looked at for weight loss, I started digging into the literature deeply. I started referring people out for programs elsewhere because we didn't have one in house. And it just. It wasn't being done right. These people were not being addressed appropriately. So because of my inability to influence their weight and because of my early belief in these medications to not only allow people to lose weight, but to begin to heal and repair their metabolism, we created our weight loss program at Modern Thyroid Clinic, which now is Replicated and being launched nationwide as Modern Weight Loss. And we are so excited to offer this to people who are not just our patients at Modern Thyroid because it truly is life changing. So that is kind of how my journey led here. Very quickly in our program, if you guys have been around here for long, you know that I am a data collector. I will mine my patients for as much data as possible to understand how their bodies are responding to things, the good, the bad. Over years we analyzed so much data about how people felt, how they were responding, how their labs were responding, and we slowly but consistently shifted our treatment paradigm in our program until now. We have a huge understanding about these medications. I have been seeing patterns in these people for two years. That research is just beginning to acknowledge and that's really what I want to talk about today. It's about so much more than weight loss. So let's talk about weight loss first. Right. So in my opinion, these medications are play such a powerful role in people that can't lose weight with effort. That doesn't necessarily mean they're obese people. It means they could have £20 to lose, £15 to lose. But if they can't lose it because of loss of metabolic potency, these medications not only allow them to lose weight, they allow them to heal their metabolism so that when they are no longer on these medications, they can lose weight with effort. But in weight loss alone, these medications have come out on top, period for weight loss. In my opinion, there is little to no reason to ever use another weight loss medication again. Historically, weight loss medications work okay. Historically, they compromise our health and wellness and safety temporarily in hopes that the long term benefit of the health gains recognized from losing weight outweigh the negatives. Well, that is not what happens with GLPs. Not only do they show significantly more weight loss and effectiveness, they make people are healthy while they are on these medications. Let's compare it to phentermine. Ventramine can reduce appetite, reduce some cravings, it's a stimulant, it can increase heart failure risk, it can increase blood pressure, which obviously people with obesity already struggle with. Baseline, essentially you are not healthy while you're on ventramine in hopes you get healthy later on a GLP. One the time duration that you're on it, you are 20 to 30% less likely to die of heart disease. You are 20 to 30% less likely to die by getting hit by a bus. In fact, your risk of death is reduced. Different studies show different things between 20 to 30% for any reason whatsoever. Which is incredible. So you are, your health is more protected while you are on these medications than off. And especially compared to other traditional weight loss medications. In fact, GLP1 show a weight loss reduction of anywhere from 15 to 20% in most studies over the course of 68 weeks, which is pretty comparable to that of gastric bypass surgery. At Modern Weight Loss, we've helped numerous patients achieve their health goals by using GLP1 medications. We are so excited to share with you some of our most effective strategies to help you optimize your GLP1 journey. While these tips reflect our approach at Modern Weight Loss, we of course encourage you to discuss them with your own healthcare provider to determine what is best for your individual needs. But if you would like to download our free guide, you can find it at glp1decoded.modernweightloss.com and of course, I'll pop that in the show notes for you. So for weight loss, I think they're unparalleled. But while patients are losing weight, they are reversing prediabetes diabetes, they're reversing insulin resistance, they're reversing leptin resistance, they are reversing the loss of metabolic pot that created this issue in the first place. They are working on healing their metabolism. And that is what we do differently at Modern weight loss and Modern Thyroid Clinic. We have very particular parameters that show us, objectively speaking, that in all likelihood, this person's metabolic function is healed to the degree that they can successfully come off of this medication, maintain weight, and lose weight with appropriate amounts of effort in the future. And that is what we're looking for. So simultaneously, while people are losing weight, if they arrive at their weight loss goal and their metabolic function is not showing that it is healed to the degree that it should be, we encourage people to continue the program in smaller doses and micro doses so that they're not actively losing weight. But we are still healing and working on that metabolic potency. That metabolic flexibility research does show that GLPs can improve metabolic flexibility. That is absolutely what our clinical data shows at Modern Thyroid Clinic over and over and over again. So we have weight loss, we have metabolic healing potential, but the benefits go so far beyond that as well. So let's talk about the number one most common benefit that we see with patients in our program. Inflammation reduction. So inflammation is the core driver of chronic disease. It is what breaks our physiology, our body down over time and yields us less and less healthy as the years go. Obviously, people with thyroid issues, especially those with autoimmune thyroid conditions clearly have inflammatory issues. But I think honestly the general population of the world, but most especially America, we, we have inflammation issues, myself included. I struggle with inflammation. If you guys follow me, you know that I'm always constantly working on my inflammatory level. I have never ever seen anything that holds a candle to the inflammatory reduction of a GLP1. I didn't expect it going into collecting data on our patients. I didn't expect to hear it over and over and over again as feedback from our patients. But the number one benefit that we see in our programs is potent anti inflammatory effects of GLP1s. I'll give you an example, I'll give you a couple. I had a patient in June who started our weight loss program and right before she started on June 26, she checked her CRP lab or HS CRP. So an HSCRP lab looks at general inflammation. It can also be considered an indication of cardiac inflammation and it also risk stratifies people for their likelihood of developing a heart attack or a stroke in their lifetime. It's sort of divided between like low risk, average risk, elevated risk. Anything above 3 is elevated risk. Obviously the higher this number is, the higher the risk that you'll have a heart attack or a stroke, which is the number one killer for men and women in our country and world. This patient got it checked the week before she started our weight loss program. It was 9.6. She did one injection of a quarter of the lowest dose of semaglutide, the generic form of oic, after her first injection. So this is one injection. Her HSCRP was four. It's really hard to elicit a reduction like that with lifestyle or supplements or medication that there really isn't medication to do that over months. She did it in a week. People over and over report after my first injection, within 36 hours, within 48 hours, within 72 hours, my inflammation plummeted. It is not uncommon for me to see HS CRP go from 35 to 10 in a few weeks, from 13 to 2. So that's taking a person at extremely high risk for cardiovascular event to average in a matter of weeks. It's pretty powerful and it's pretty unreplicatable. Especially the importance of this cannot be understated because again, heart disease kills more people than all cancer combined. I'm going to say that again. Heart disease kills more people than all cancer combined. And your likelihood of dying of heart disease on a GLP1 is reduced anywhere from 20 to 30%. That's incredible. So that is one example now. I mean, I've been screaming this for two years. I have been preaching this. A study came out a couple months ago that says, you know what? We are seeing early reductions in HSCRP because they were looking at them in 12 and 24 month periods. That's a long time after you start. What I am seeing and what I am saying is people's inflammatory responses are reducing immediately. Now they're looking at them in studies as early as six weeks, which is great. It is a huge improvement. Again, let's turn back that clock even more because I think we would be shocked to find it is reducing far before the six week mark. One more example from an inflammatory standpoint, and this is more like a rheumatological. I had a patient who was in our thyroid clinic, modern thyroid clinic. I gave her back her life. She was doing amazing. She was doing awesome. Her and her husband went on vacation to Mexico. They came back, she got some kind of a, a GI issue there. And it put her body into one of the most severe inflammatory states I've ever seen in medicine. She flew all over the country looking for treatment, did all sorts of conventional and alternative treatments. Nothing helped. Her last resort option from Stanford was to go on methotrexate, which is an immunosuppressive drug or cancer drug. It's not something that someone wants to take forever. I'm like, listen, let's just try a micro dose of a GLP and see. And this is after months of her trying everything else. 24 hours after her first injection, she said 95% of her inflammation was gone. Slowly. If she doesn't inject after 10 days, it comes back. But that wildly inflammatory response that her body was living in, that took her an hour and a half to get out of bed every morning because of the pain, was so bad, turned down in 24 hours. Research also shows reductions in the progression in severity of rheumatoid arthritis, of osteoarthritis. These are not just my findings. Research is backing up what I am seeing day in and day out. Another improvement that I bet you wouldn't expect. Gut health. I know you guys hear all day, every day, these are so bad for your gut. They can cause sibo, they can cause gastroparesis. Can they do all those things? Yes. Everything in medicine is a balance of risk and benefit, of pros and cons. Nothing is all good. Rarely are things all bad or all good. The world is not black and white, right? In part, it's the inflammatory reduction People start these injections, their gut is less reactive, they tolerate foods better, they are not as bloated, their lining of their intestine is no longer in this chronic inflammatory state. It's able to heal, it's able to seal back up. And research also shows this. I'll tell you a story of another dear, dear patient of mine who is just an absolutely incredible woman. She's about my age, she's an entrepreneur, wildly successful, but has had intestinal colitis since she was 5. So for a patient that is a wildly successful woman in her mid-40s who literally struggled with bowel incontinence her entire life, to be able to solve that problem unlocks a whole different era of her life that she has struggled with since childhood. And again, this is one of many stories, it's one of the more profound ones that I've experienced firsthand. Lastly, and there's a million I will, I'll have to do a podcast episode simply about all the other things that this particular class of medication can impact for longevity, for health, for wellness. But the last thing I did want to bring up that I think is worth while even in a shorter form conversation, is the improvement that can be seen in Alzheimer's and Parkinson's. So the neuroprotective impacts of these medications are extremely powerful. Our countries burden in health care currently, but what will be in the future as well is enormous. Alzheimer's and dementia is an incredibly expensive healthcare burden family and I don't want to say burden, but it is a very difficult thing to navigate. So if we can improve that as well with these meds, we could change the future of so many families, so many people, our entire country's healthcare system. And you know, A study in 2021 found that treatment with GLPS resulted in a 43% reduction in brain atrophy in cases of Alzheimer's compared to a placebo. 43%. That is. I don't know the treatment statistics for the current Alzheimer's treatment medication, but they're not even close to 43% reduction. So if we could have people on this early on, could we prevent Alzheimer's, could we slow the progression of it so substantially that it is almost a non issue that people die of other natural causes before they die of Alzheimer's, that they don't have to go into nursing homes so early in their life because the progression is now so slow? Definitely something to think about. Again, this is scratching the surface and so the next kind of phase of this conversation that I think this evolves into is. I know that you all hear a million bad things about these drugs. I know that you hear the side effects are so profound they're unbearable. I know that you hear that they cause thyroid cancer. I know that you hear just one after the other this recycled fear mongering that's happening in the media. And here's what I want to convey about that. And I want to touch on a few things specifically, especially the thyroid piece, because thyroid is my thing. Right. Number one is everything in the world has pros and cons. Everything has risks and benefits. You guys are just being given an amplified version of the risks for these meds and really are not being given the stories on all the benefits. Right. We are fear mongering in the media to an enormous degree. And it's a pretty one sided conversation. But I think where we need to start this conversation is so much of the side effects associated with these medications. Nausea, vomiting, gastroparesis, pancreatitis, these are dose dependent. And the problem is is people are being over medicated. We are using doses that we created for diabetics for people that do not have diabetes. And it is to much. Okay. We have in happenstance over the years ended up at utilizing micro doing in our programs because we found that after tailoring doses to people over and over and over, adjusting them in nuanced ways, we found that people need a heck of a lot less medication than they're being given. They don't need to increase their dose every month. These doses are effective for far longer than a month at a time. And we are unnecessarily and wildly over medicating people. So if we want to deal with side effects, start with the dose. I prescribed my first Zofran prescription in a year a few weeks ago just to give the patient safety of mind. Because we don't even have people get nauseous anymore. I mean, we just do not have significant side effects. We have never had one truly significant side effect. But at this point we hardly have people who struggle with mild side effects. You know, when it comes to things like thyroid cancer. Let's talk about this. And you can kind of cherry pick literature either way. I think truly people who are educated on the studies and risk of thyroid cancer, it all boils down to this. And I'll give you my take as well. During early studies, these medications were given to rats at much higher doses compared to humans. Right? And rats happen to have an incredibly high density of GLP1 receptors on their thyroid glands. So a very high receptor Count combined with much higher dosing led to an increased risk of a specific kind of thyroid cancer called medullary thyroid carcinoma. That has not translated to human studies. In fact, the FDA kept that black box warning on simply for rats, not for cases of human studies. Multiple studies have come out, including meta analysis that really say rates for thyroid cancer. Medullary thyroid carcinoma in people on GLPs versus not. There's really not a statistically significant difference. There's not that is specific for medullary thyroid carcinoma. It makes me angry that people in medicine are regurgitating not real facts. That people with Hashimoto's can't take these meds because they're at increased risk for thyroid cancer. That people with thyroid problems can't take these meds. That is so not true. In fact, some of the people that need these medications the most have a thyroid condition. And again, everything is weighed personally with your clinician, right? So if one of my patients has a history of papillary thyroid carcinoma, we are going to talk through risk benefits, alternatives of starting GLPs. I feel more than comfortable starting those people on a glp. All of my patients with that history feel more than comfortable starting a glp. But some people wouldn't. And that is for you and your clinician to decide. The only contraindication when it comes to thyroid and GLP1 medications is a history or family history of medullary thyroid carcinoma. That is roughly 3% of thyroid cancers. That is not any nodule. That is not a random thyroid cancer. That is not Hashimoto's. No, no, no. The only people that are not recommended to take these meds are people with a history or family history of medullary thyroid carcinoma or multiple endocrine. Neoplasia. That's it. Everyone else gets the green light. Everyone else also has to weigh their own risks and benefits and alternatives. But that is the fact, and that is the bottom line. When I started our program, of course, my, my niche is thyroid. So I wanted to be sure that I was protecting people's thyroid glands. So we got people to get an ultrasound every three months. We've done it for years. We no longer make it mandatory because we never had an issue. We. It just was not an issue. People were not developing nodules. Their nodules were not changing. We weren't seeing things that were concerning for us. So now we do certainly give everyone at modern thyroid clinic the option to get a thyroid ultrasound every three months to ensure that nothing is changing. Do I think it's necessary? No. Would I personally do it? No. Do I offer it to my patients? Of course. And absolutely. So what are my thoughts on the risk of thyroid cancer? And GLP wants. If you want to be afraid of something in your life and in your health, it needs to be heart disease. That is what is going to kill most of us. It is what is going to create disease in most of us. And statistically speaking, that is how the majority of us will die more than again, all cancer combined. So if we want to weigh risk versus benefit in medicine of an extremely rare form of thyroid cancer that progresses wildly pretty slowly versus a risk reduction of 20 to 30% in your likelihood to die of heart disease, I'm sure you could infer which one I would pick every time. Also while reducing your inflammation, also while reducing your likelihood to develop Alzheimer's and dementia, the progression of rheumatoid arthritis, osteoarthritis. That's my take on it. Gastroparesis, again, reduce the dose, reduce the constipation, reduce the overall large reduction in motility. There's your answer. Pancreatitis. Pancreatitis comes at an increased risk with weight loss. It doesn't matter if you are losing weight naturally or you're losing weight on a GLP1. Pancreatitis is a risk. Pancreatic cancer comes, is increased in cases of pancreatitis. Right? So GLP1s don't increase your risk for pancreatic cancer. They increase your risk for pancreatitis because you're losing weight again. Lose weight slowly, you're at less risk. Don't overdose yourself on medication, you're at less risk. And then the last category of side effects I want to address before I answer some questions on social about this topic is ozempic face Ozempic butt loss of muscle mass. Guys, the loss of muscle mass is so silly. And I think it's especially silly in the world of functional medicine because they are latching onto that and just repeating it as if it's truth. As if these medications just go in and strip you from your muscle mass. They do not. Period. Full stop, End of story. You know what creates loss of muscle mass? Severe calorie deficit. And people aren't eating protein. You know what causes that overdosing on medication. You know what prevents that? You reduce the dose of medication. You ensure that you're getting enough protein. You don't suppress your appetite to the degree that you cannot eat food and micronutrients, nutrients and Macronutrients and you don't take so much that you're so tired that you can't go to the gym and lift weights. It is more than possible to increase your muscle mass on a GLP1. It is just as possible to increase your muscle mass on a GLP1 as it is to increase your muscle mass, not on a GLP1, period. Full stop. We have people increasing muscle mass all day, every day on our program. And you know what else the bonuses is? You can actually see that increase muscle mass because they lose enough fat to show it. Whereas so many of these people have poured blood, sweat and tears into building muscle at the gym that they could never see or realize because it was covered in a layer of fat that they were not able to lose despite their best diet and exercise efforts. If you don't want to lose your collagen, you don't want to lose your muscle, you don't want to lose your hair on GLP1s, the answer is simple. Eat food, eat protein, eat micronutrients, move your body. The answer's the same as it is without a GLP1. And it's as simple as that. There is nothing magical about these medications making people lose collagen. But that's not what the media is telling you. The media is telling you a wildly different story. And you need to be careful what you're believing and where you're getting your information, because most of it is simply not true. Having said all that, clearly you can tell that I do not view these medications as something that should be taken and not having addressed lifestyle. I think these medications go adjunctively with lifestyle, with a healthy lifestyle or lifestyle improvements. If you don't go into taking these medications already with a good lifestyle, you surely need to be working on developing one while you're on it, especially if you plan on coming off, especially if you don't want to lose muscle mass, especially if you don't want to lose collagen. Right? You can do it the lazy way and you're going to have less long term success, or you can do it the right way, with the right clinician, with the right approach, with the lifestyle habits that you need to set yourself up for long term success. And that is where those two roads diverge. You have to put in the work to see the results, even in the case of GLP1s. But I want the world to recognize that just because people are taking GLP1s does not mean they're lazy. It does not mean they're taking the easy way out. A lot of people do not have another way out. There is no diet and exercise that will work for them. And again, those people need to be accounted for. They need to have a place to go. They need to have a solution and this provides an extremely powerful solution for them. So having said all of that, this was fun. I want to just scroll through and answer a few quick questions from people from social Can GLPs come in pill form? They will soon. I don't use them yet. They haven't had as much success and they tend to have more side effects. GLP1 and Adrenal function. Again, this is where protein comes in. This is where salt I actually have my people on GLP1s take a half or a quarter teaspoon of high quality salt and water one or two times a day. GLP1s definitely decrease hydration. They definitely need extra salt and you need to be sure you are fueling your body adequately. GLPs and constipation concerns this is dosing. This is reducing dosing till constipation isn't a big issue. And it's also supplementing with magnesium citrate. I love pure encapsulations. Can you use GLP1s post thyroid cancer? I already answered that question. In my opinion, absolutely. With the exception of a history of medullary thyroid carcinoma or men GLPs while microdose while breastfeeding a one year old, I would say no. I do not say that GLP1s are safe for breastfeeding or pregnancy. GLP1 safe with thyroid nodules in my opinion. In my opinion only. This is to be decided by you and your clinician. Absolutely. I would do this. Who is a good candidate for GLPs? What questions should one ask their provider? One I think people who already have a good lifestyle and are willing to complement their GLP 1 usage with a good lifestyle and 2 my favorite people to use GLP 1s with are people who cannot effectively lose weight with effort. Questions to ask your provider do you tailor dosage per person? How often do I meet with you about dosage, et cetera? How can I reach you if I have trouble? Another question how long can you stay on a microdose of a GLP1? These medications are studied for lifelong use, so in my opinion that's your answer. What is considered a microdose of a glp? I think this is the Wild West. I think it can be anything from a tenth of a dose or less to a quarter of the dose or half of the dose. I think that that's a subjective question. I don't think there is no finite answer. And I think a microdose in my opinion is the least amount of medication possible that elicits the effect that is needed. Have you heard any physiological effects off after coming off of a glp? I mean metabolic improvement is kind of our gold standard of what we're looking for. However, one thing I can tell you is people who have high, high inflammation go on GLPs get inflammatory improvement. That inflammation comes back that that GLP itself influences at least for four inflammatory pathways that I found in research. That does not stay gone. If you come off of a glp, would you stay on a GLP one forever, cycle it or wean off? I think that is tailored to you and that is why you need a clinician that is willing to tailor their program to you. It depends on your goals and your responses. Seeing ads for natural GLP1 boosters, legit some I think can be beneficial. You are never going to going to get the same effect as like, you know, GLP1 based medication. So it's all about setting expectations. Tips on hair loss, micronutrients, green juice, neutrophil protein, collagen. Okay guys, that's all the questions I can take for now. Let's do another one of these. Maybe I'll do a whole episode on questions and answers. Thanks for tuning in and talk soon.