10: The Greatest Myths About GLP-1 Medications Debunked! With Sally Sykes

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. I am here today. We are here today with a very special guest, one of our team members at Modern Thyroid Clinic and Modern Weight loss. This is Sally Sykes, and she is a key. Cannot live without her person for our weight loss program, for our GLP program. Welcome, Sally.

Thank you. I'm so excited. This is so fun.

I know. This is so fun. We've been wanting to geek out and do this for a very long time.

Many months.

Yes. I'm so happy it's finally happening.

Totally.

I would love for you to tell people a little bit about you, your story, why you're impassioned about these medications, because I know that you are and just share a little bit.

So, you guys, I used to be an attorney, and then my dad was diagnosed with Alzheimer's disease, and that kind of took me down a trail. He was very young when he died of functional medicine. You know, there's no cure for Alzheimer's disease, but what can we do to prevent it? Right. And they're calling Alzheimer's disease type 3 diabetes. So I'm finding all the root causes of so many of these diseases of aging are rooted in insulin resistance. And so I became a functional medicine health coach and left the law, and I've been doing that ever since. I'm really passionate about functional lab analysis, so. So looking at labs from an optimal standpoint versus the normal ranges that are kind of the average of all the sick Americans. And I've been working with patients on GLP1 meds for almost four years now, and they are making incredible changes in people's lives. We're going to talk about all the things that they do and dispel some myths. But, yeah, that's how I got here.

Well, we are so happy that you're with us. Like, absolutely. Our patients love you. It's not a surprise. You're absolutely incredible. So today we are going to be dispelling myths. This is our first in a series, series of a few podcasts and a few discussions and content where we want to bring you guys, like, real information that you're not really getting anywhere else. There's a whole other side of this narrative that isn't really being spoken, and we want to bring that to you. So we're excited to do that today. We are going to debunk GLP myths. And we are just going to, you know, quickly go through some key basic things, but then also dig into all of these myths. So a little introduction about GLP based one medications in general. I'll just start and add anything that you feel like is worthwhile. GLPs were initially created in order to treat diabetics for high blood sugar. This was actually about 20 years ago. Yeah. So these meds have been around for a couple decades. They are not new.

Lots of safety data.

More safety data is what I don't think people know. There is more safety data on these meds than happens with any other, like FDA approved medication.

Totally. Yeah.

So we are a couple decades in. What they noticed during diabetes studies was, gosh, these people are losing weight. Like, what's going on? Can these be used for weight loss? And so several years ago, we started looking into them specifically for weight loss. That is only the beginning.

Tip of the iceberg.

Yeah, tip of the iceberg in my opinion, and I think Sally feels the same. Weight loss is an added benefit to these medications. It's like a bonus. The benefits of all the people get outside of weight loss are so much more powerful than the weight loss itself. And they are not dependent on weight loss. So always like to clarify that GLPs act in a few different ways. So if you're not familiar with what these medications are, they are drugs like Semaglutide, Tirzepatide, Manjaro, Ozempic, a Zepp bound WeGovy. Those are the big, the injectable forms that have kind of been sweeping the nation. They impact your ability to feel full, feel satisfied, not feel hungry, curb cravings. They slow your gastric emptying. They make your body start pulling excess blood sugar out so that it can reverse insulin resistance, leptin resistance. We'll start to dig into all of that. But those are the main weight loss mechanisms. There are a lot of other mechanisms happening under the surface which we'll get into in our next podcast where we talk about all the other benefits of these medications outside of weight loss. But that's kind of how they act. That's the basics. Anything that you would add?

I mean, I would say they act in the gut, but they also act in the brain Right. On the satiety signals and the dopamine signaling. So we'll talk about some of the benefits in, you know, sort of curbing cravings, but not only that, but addictive behaviors. Right. Like binge eating disorder, which is the most common eating disorder in this country that nobody wants to talk about because there's so much shame, there shouldn't be surrounding it. Right, Right.

Absolutely. Absolutely. So let's talk about misconception number one.

Okay, let's do it.

GLPs are just for weight loss, right? Yes, absolutely. Absolutely. What do you feel like? Because I know we went into this program years ago. We're going on year three now.

Yeah.

Knowing a little bit about what to expect. But what are some of the most surprising things that you've seen in working with patients?

So. Right. We start patients on such low doses. Right. So. Which is incredible because we're not seeing a ton of the side effects. But even at the low doses, a lot of times, you know, you're not seeing weight loss. But we are seeing, because we're tracking labs, massive reductions in inflammation almost immediately. Right. Reductions in inflammatory markers, triglycerides, which is a real metabolic marker. Not only that, but blood sugar normalizing. What's really cool is GLP is they don't plummet blood sugar, which is really cool. They normalize it. So if you're tracking your blood sugar, you'll start to see it look very metabolically healthy versus these, like, huge peaks and valleys. That's the kind of the hallmark of insulin resistance. I mean, chronic pain, psoriatic arthritis, autoimmune antibodies, name it. People are even talking about. I had some patient at my last clinic who didn't have to take her ADHD medicine. If she kept up with her. They're talking about the neuroinflammation, that it's calming down, which some people are describing, you know, better. Fewer symptoms of their ADHD or depression or anxiety is fascinating. I think we've just barely scratched the surface of these web medications.

And I think, like, almost now, like, every day, every week, there's new studies coming out about all these other uses for them. That is just. I'm so happy that other people in medicine doing studies, putting in the effort, are realizing and investing and looking at all all these other benefits. I would say my. I don't think I can narrow down to one most surprising thing, but I would say too are definitely inflammation. I just. We have a patient. I know. I won't say her name. She wouldn't care if I did. But we'll call her G. She went in, she was so. Doing so amazing, like on thyroid hormones. Just incredible. Got her life back, went to Mexico, got some kind of an infection, came home, and she was massively inflamed. Yeah. It took her an hour and a half to get out of bed every day. She went from feeling like a 9, 10 out of 10 to an hour and a half to get out of bed. Couldn't walk, extreme joint pain. Flew all over the country to get all kinds of treatments, went to Stanford, would do anything, spend any amount of money. And finally I'm like, listen, listen, G. I think we should try a micro dose of a GLP. Yeah. She wrote me back 24 hours later and said 95% of her inflammation.

Yeah.

Was gone in 24 hours. On a microdose.

Yes.

Yeah.

Micro dose, you guys. Yeah. I had a similar patient a few years ago who had had. She was a model. She had psoriasis scalp since childhood. Within two weeks.

Yeah.

Gone. She was like crying in, in our office, like. And I just, at that time I didn't really know that. And then we started seeing it, but it's more and more.

Yeah. The other thing that I never would have guessed and I was suspicious about inflammation, which is why we've tracked inflammatory markers the whole time. But the whole disordered eating.

Yeah.

Thing going from women who have not been able to influence their weight doesn't matter if they eat, exercise, they cannot lose pounds, can hardly maintain their weight if they don't eat right. They start restricting more and more and more and more. Feeling guilty every time they eat, feeling ashamed every time they beating themselves up for fueling their bodies. Right. They go from that to getting on a glp, starting to have a normal physiological response to food, a healthy one. You're. They're not needing to over restrict to lose weight. They don't beat themselves up every time they eat and they develop the sense of food freedom. I never would have imagined that three years ago, four years ago.

Yeah.

But it is one of the most common things that I hear.

I mean, you read this, women talk about their Roman Empire and so many people will post that. My Roman Empire is that I've thought about my weight since I was 8 years old and bring up that mental space for women with all these beautiful gifts to bring to the world. Like the mental load conversation. Jerry, I just feel like is just a side benefit that maybe not people aren't maybe thinking about, but that I see kind of every day.

Right. Like we don't want our weight to like dominate our mental landscape. We don't want that to be the case. Right. But unfortunately, for whatever reason, we are programmed from society that we use a lot of our mental capacity thinking about our weight. And so really to free that up, to not have all of those emotions Tied up is so powerful. Really, truly so powerful. Misconception number two, side effects are unbearable.

Love this one. This one is fantastic, right? It depends on the program you're in. So get in a good program that has coaching that is going to personalize the dose for you. Because this is dose dependent, Right? You say this over and over again. Yeah. Like if you go take a whole bottle of Tylenol, you're going to end up probably dead or in the hospital. Right. But if you take one, maybe you're headache go away. Right. If you take too high of a dose of a GLP1 Med, you're probably going to feel real sick, especially if you don't follow. Have a program that's advising you on how to avoid the side effects, right. Maybe don't drink alcohol, maybe avoid gluten, have smaller portion sizes, don't eat before bed, blah, blah, blah. But yeah, it's. The side effects are dependent on how big the dose is and how good your coaching and guidance is in the program. Right. Because if you've not been given any guidance that I call that the diagnosis adios. Right. You just given the, the like prescription and you're just out of there and you're like, all right, I guess I'm doing this at home. And people just, they lose. Might lose weight because they're eating the same amount of the bad food they were eating before, but they're not peeling their metabolism. They're having terrible side effects because they don't realize there's a connection between those. And so, yeah, there doesn't have to be.

It doesn't. And we started our program on standard dosing and slowly over time, we started like pulling back the dose, trying to find what works for people that is still effective without side effects. And now I think we really have it. I mean, we're always evolving. The reality is we don't really stay stagnant. We collect data and we evolve. We collect data and we evolve. And so right now where we are is we're in a place where one, we've never had any significant side effects. Two, we hardly prescribe Zofran anymore, like anti nausea med. Like I think I've sent one in in the last year.

Yeah, honestly, I think you're correct. And it's great because Zofran can make you tired and foggy and it kind of tends to stop weight loss. So it's like, why are we putting these patients are spending all this money on a weight loss medication and then they're feeling sick and now we're having to do polypharmacy to do, it's like, well maybe we just lower the dose.

Right. And so what I think where we're headed, I think is we have been basing dosing on people for weight loss on people with diabetes and that is not like what needs to be happening. People that are on these meds just to lose weight do not need the same amount of medication as people who are diabetics.

True.

And so what is happening in terms of side effects and why you all are hearing all of these nightmare stories in the media is because people are on too high of a dose. They are not being managed. So we're putting them on these high doses. They're not eating food.

No.

They're just starving themselves, not meeting their protein goals.

They're losing muscle mass.

They're losing muscle mass, they're losing collagen because they're so over medicated. They don't have an appetite and they're force feeding themselves carbohydrates all day.

Yeah.

And yeah. Right. You want to know a really good way to lose muscle mass?

Yeah. Not eat protein and not heal your metabolism.

Not heal your metabolism.

You're mainlining carbs. Right. You're still going to be super insulin resistant even if you're just eating fewer.

Of them and you're so tired you can't work out.

Oh good.

Yeah.

That's not a good place to be. Should we talk about the difference between compounded and the brand names, all that.

Have got to do and everything? Yeah, I think we should. So what's happening in America, right is we have these preloaded pens. The dosing is not easy to adjust. It's often like people are winging it trying to navigate this micro dosing idea. And so yeah, let's introduce the topic of micro dosing and then compounds versus regular.

Yeah. So the brand names. Right. So Semaglutide is the name of the medication. Some glutide is Ozempic for diabetes and Wegovy for weight loss. Then you've got Tirzepatide which is kind of the name of the name of the medication. And that is going to be Manjaro for diabetes and Zepp bound for weight loss. So they come in these pre dosed self injector pens. And the problem is. Well there's multiple issues with them. The affordability problem is huge. Right. So if you can even find them, getting your doctor to prescribe them, getting them covered by insurance is virtually impossible.

I have a coaching on a monthly basis after get approval Again, yes.

And it's like 2000. I heard somebody is 20$500 MET. So even if you are made of money, you have managed to get a prescription for one of these, then the challenge is finding it in stock at a pharmacy because there are national shortages. So you're going from pharmacy to pharmacy to try to find it, and this becomes really tricky. Not only that, so then the self injector pens, you're stuck with a certain dose, so it becomes you can't do a smaller dose. And that's where you really see a lot of the side effects, side effects with people, because they are just stuck with one dose and they can't personalize it to them like you can when you have a compound at home and you can really titrate it along with your doctor.

So. Right. And like, for example, one tip and trick we do at Modern Weight Loss and Modern Thyroid Clinic's weight loss program is we split dosing totally. We're like, okay, well, if this smaller dose is too much for you, let's reduce it in half. You'll inject half on, for example, a Monday and half three days, four days later on Thursday, so that the peak of the medication doesn't hit so high that you're getting nauseous and fatigued and not eating. We want to level out that peak throughout the week. Again, you can't really do that with a preloaded pen.

Exactly. You know, people are saying they also like splitting their dose too, that it works well for people who have side effects, but also works well for people whose cravings are coming back at like day five. That they're getting a little more longevity out of their dose, which I love that.

Yep.

You still have to get some more syringes on Amazon or wherever if you're running through them faster. But I love it. I think personalizing is where this is going for sure.

And the misconception too, about compounding drugs in general is such a shame. I mean, I think it really is a narrative being pushed by pharmaceutical companies who don't want people to think that compounds are good. Are there poor compounding pharmacies? Sure. Let me tell you. To get a license as a compounding pharmacy for injectable sterile medications is an incredibly long process, extremely rigorous, extremely scrutinized by the fda, et cetera, and. Or the governing body. And so it's not just happenstance. Like, it's not just, oh, well, today we decided we're going to start making tirzepatite. No, like, it is very legitimate. We use Very high quality compounding pharmacies, but a lot of them are high quality. And so really the power gets into not where you're getting your compound from, but your prescriber, your program, your partners in this journey are what make and break, especially side effects.

Definitely. And long term sustainable weight loss that you're going to keep off for the rest of your life. Because it's, you know, these are not cheap. Even the compounded.

No.

Yeah, you want, you don't want to waste all your money and have it all come back.

So absolutely not. Yeah.

So side effects are not unbearable, like as long as the dosing is right. And you've got a practitioner who's really, really experienced in this and who's got a 360 program with diet, lifestyle, how to avoid side effects and that you're able to get someone on the phone when you need them. You know, there's a good amount of.

Support, troubleshooting and that's really what I think. Like makes our program pretty special. Like, we do not just prescribe and be like, good luck. We have weekly calls that you can join. We have weekly educational lab reviews that you can participate in. We have a private community that you can be a part of. You know, you have resources, you follow up often with your clinician. We run labs every three months so that we can analyze data of how things are going for you. The last thing we do is just give someone medication and be like, we'll figure it out. You have a course that you follow along week by week where we're like teaching you exactly what to do and tips and tricks and all the things. So makes it super easy to course.

Correct, like just immediately.

Right.

And we're just. Yeah.

Which ultimately that's what makes our program unique. Like, we tailor this to you. We have a framework that we basically base it off of, but week by week we adjust people's dose if we need to.

Yeah, definitely.

Literally. Yeah. Misconception number three. You kind of touched on this a minute ago. GLPs are a miracle drug or a quick fix. So much more goes into sustainable weight loss than just taking this injection and everything gets better. Tell me your thoughts.

Definitely. I mean the miracle drug part almost it is, right? Honestly, like, the more we learn about it, I'm kind of like, is this the most important discovery we've had in medicine since penicillin? I don't know. It might be like. And yeah, we'll keep you updated. I was thinking about the kidney function study that was just blew my mind. You guys side Note on this. They were comparing patients on semaglutide, patients not on semaglutide. They literally had to stop the study in the middle because the patients on semaglutide, their kidney function was improving so much. They determined it was not ethical to continue the study and not give the medication to the control group. What. That's anyway, right. That's a side note, but not a quick fix. Especially when you start low and slow like we do. Like the heads out is the healthy way to do it. You might not lose any weight for the first two months. You might not. And we said expectations from the beginning. And so, yeah, this is. We're in it for the long game. To start to heal the metabolism, your body has to get used to these medications. They're titrated up slowly. You can't just, I can't just throw you on 2.4 milligrams of semaglutide like you'd be in the hospital.

Right.

You have to do it slowly. And so it's well tolerated. And also it takes time to change diet and lifestyle. Right. I mean, good grief. I had type 2 diabetes. And that's because I grew up in the 80s with everybody saying, fat free.

This, lots of carbs.

Oh, so many carbs. Right. Remember the food pyramid? It was just all, you know, baguettes, pasta, crackers, waffles, all the things. Well, that was my diet. And my mom and my sisters and I were all insulin resistant and a hot mess. And it was so hard to turn my brain around and say, I can eat the skin on the chicken. I can really like, I can eat good fats that are actually from animals that are natural sources and focus on protein and good fats and just, just get rid of the, you know, I thought candy corn was a health food because it was fat free. It was fat free. I was basically eating candles and getting diabetics. So, yeah. So it is not a quick fix. But the low starting doses allow you also the time to make those changes. That can sometimes be hard. Right. Cleaning out your pantry, learning what to eat, getting a new shopping list. We offer shopping lists and recipe ideas and we're talking about it all the time on the Facebook group and sharing recipes. So it gives you time is you want to develop habits that you can stick with for the long term. This isn't a. Lose it quickly and then go right back to where, what you were doing before. Right.

Or, you know, like, if you're not focusing on your diet while you're in the program. If you're not eating protein, you're going to lose muscle mass. If you're not eating protein, you're going to lose collagen. If you're not eating protein and micronutrients, you're going to lose hair. Yeah, Right. So it's not as simple as take this, do nothing else, and everything is going to be wonderful. That is not the way that it goes. And then obviously, too secondary to that is you want to build muscle during the program so that your basal metabolic rate when you come off and we'll talk about if that's possible soon, your basal metabolic rate is up. Like you can burn more calories doing nothing.

Exactly.

And maintain that success. And so, sure. I mean, I view these drugs, I agree, they are a miracle drug. They're the biggest thing in medicine that will happen in my lifetime and they are our modern day discovery of antibiotics. But you also have to put effort in with your lifestyle to be successful and not have side effects.

Exactly. And, you know, and a lot of our patients are already doing all the things with the lifestyle and lifestyle. But then there are also things, you know, especially if you're a modern thyroid patient, which I always love it if patients are full circle doing thyroid and hormones and stuff with us, because sometimes, right, you're doing all the things of the diet, lifestyle, you've optimized your metabolism side. But maybe we're not replacing hormones yet. Baby thyroid is not optimized. So all of those can play a role. And, and I love that modern thyroid does all those things, even if they come in just for the weight loss, if they, you know, hit a stall. I mean, we've had so many times, they're like, just do it all for me. And I'm like, yes. That's how we got connected is I was saying, like all of my coaching clients, Right.

Like, I think I need to call her.

I'm so glad you did. I was like, I don't know anybody else who does the trifecta for women. Right. Like thyroid hormones, weight loss, like everything else. Like, I can go get doc in the box for.

Right.

You do it all. And everybody is so amazing. Like, and that's. It was client feedback, honestly, that I was like, this is where you need to go. Because everybody who works at modern thyroid has their own story. There's no medical gaslighting or shaming. And it's just, it's a beautiful place to be.

It is. It's a safe place. Yep. You know, and I wanted to add too, like, about what you were Speaking to about thyroid hormones. The importance of addressing all those things. It's funny. So when people come to us, some people come and they want thyroid. We fix their OR. They've been our patients for 10 years. We've had their thyroid perfect. They still have trouble losing weight because of metabolic resistance. So we start them in our weight loss program. There is a significant difference between those people and people who show up and say, I want to start thyroid treatment and GLP at the same time. These people go slower. Right. Because the under the foundation hasn't been done yet. And so it speaks so much. When I see people on social media who are like, I'm stalled. I can't lose weight on a glp. I'm like, listen, you gotta get your thyroid and your hormones in order to. Because otherwise the same reason you gained weight in the first place is just going to either hold you back from losing weight or create a recurrence.

Exactly. Did you read that study that the women who were replacing hormones and on GLPs lose 30% more weight than women who are not replaced?

Can you send me that study? I missed that. And that is huge.

It is. And it doesn't surprise me at all. Right. When you lose and we lose our estrogen, progesterone and testosterone, it affects our metabolic sensitivity and potent massively. And, you know, if we low testosterone, we are not building muscle mass. I mean, my muscle mass after testosterone now, I don't know if you could see it. It's still pretty sad. But like, it's so much better than it was and huge. And that. That is your metabolism that's keeping me from reactivating the type 2 diabetes, which I feel like is a little bit like being a recovering alcoholic with sugar. As long as I can stay away from sugar. I don't have type 2 diabetes.

Right, right. Oh, my gosh. I read a study earlier that I think it was 31% of people got type 2 diabetes reversed. I was trying to find it, I don't know where.

On glp.

On jlp.

Yeah. That doesn't surprise me. Right.

That's amazing. I mean, and that's the standard people who honestly probably aren't doing a whole lot for their lifestyle. So imagine that statistic with our patients.

Exactly.

Yeah.

Who are doing all the things.

Who are doing all the things. Yeah. Misconception number four. Once you start, you can never stop. Mic dropped. Let's talk about it.

Let's talk about it. Yeah. Not our patients. Right. So this is what's really cool about our program is we Are getting labs, very specific labs on you that having to do with metabolism and inflammation, lipids before you take your first injection. And then every time you get a new file, we're getting new labs on you and we can start to compare. So we're seeing how your metabolism is healing. And I love this. I always encourage patients to sign up for the first lab review after they get their first labs and definitely the second one because they may not have lost any weight during that time. And I want to catch them when they're a little frustrated and they need a non scale victory because we see that the changes in the labs, the lowered inflammation, the lower triglycerides, glucose, A1C, insulin. Right. Insulin is the fat storage hormone. It tells our bodies to store fat rather than burn it. When you have high elevated fasting insulin, you literally could gain weight eating air. So I almost love seeing high fasting insulin because you can tell somebody it's not your fault. I believe you. You are not eating bon bons at home alone. Like, if you have high fasting insulin, you literally, your body is being told 24, 7, even in a fasted state that store, store, store, store bat, right? So it's like there's a reason. And it takes the longest time for fasting insulin to come down, right? Your fasting glucose will come down within a week. The A1C is that average blood sugar over three months. That'll come down in about three months.

Months.

And then the fasting insulin, you know, depending on how high it is, can take years, but with GLP1, it can come down quicker, which is really great. But yeah, you, once you stop, you can never stop. You can definitely stop if you get your metabolism in order fueled. And we see it every single day. And that's how we help patients determine when to stop successfully come off. And that may happen. You know, a patient may reach their goal weight and then and still have some metabolic feeling to do so at that point we can sort of say, well, do we lower the dose down and keep them on like a tiny microdose? So they're not losing weight anymore, but they're continuing to heal the metabolism. And then they pop off when all we are using optimal ranges. Again, you were getting your metabolism optimized. And then they puff off. And once that happens, they can maintain, we see it or continue to lose.

Or continue to guys. And seriously, I had a patient over summer who's like, I went and traveled in Italy for like five weeks off meds. She had already come off meds, lost weight yeah. While she was eating everything in Europe for five weeks. And we have very particular protocols that we look for. I don't. I haven't decided to share them publicly yet because they're still sort of a little. I feel a little protective of them. But we look for all these specific numbers that show objective metabolic healing so that we can know when patients are ready to come off successfully. And we find again. And if they wait until those numbers show up showing metabolic healing and not loss of metabolic potency, metabolic resistance, they get success. Well, there's a few people who don't want to discontinue treatment. And I'll tell you, the people that I find that are like that.

Yeah.

The number one group of people who gets to their goal weight, who gets metabolic healing, that does not want to come off of these meds are inflamed people. Yes. Yeah. Like, there is nothing that I've ever seen in medicine from an inflammatory standpoint that compares to a glp. Yeah. Not a lifestyle intervention, not a medication. Literally nothing. I'll have to tell you a fascinating story in a second about a patient, and maybe you've heard me say it before, but people who are inflamed GLPs interfere with or interrupt about four different pathways of inflammation that I found in research. There could be way more. Like, again, we're still early in this process. Right. So who knows? But literally, outside of weight loss, zero weight loss, it influences four inflammatory pathways, which has enormous longevity impacts and health impacts that we'll dig in in our next episode. But those people don't want to come off because the reality is their inflammation comes back.

It does. And it can come back quickly. And I, you know, I'm not sure, you know, what it is, but if it's coming back quickly, I mean, we've had patients say their cardiologist is like, stay on. This is looking really good. Let's just stay on, you know, low dose. And we're here for that, right? Oh, yeah. It's all about personalization because you can stay on a low maintenance dose. I have a friend who's been on it. She lost 30 pounds in three or four months several years ago. She's been maintaining ever since. And she maintains on a low dose, just injected every two to four weeks. Then she'll travel and she won't be.

On it for a while.

And then she tends to go back to weekly during. From October to January, when it's like Halloween candy and Thanksgiving pies and Christmas cookies and champagne New Year. So I think it's really interesting how these can be personalized and cycled at very low doses. Right.

Amen. The personalization is such a powerful thing and empowering thing for these people because again, they don't go into the holidays terrified now. Yes. You know, they don't feel afraid that the five pounds they're going to gain between Thanksgiving and Christmas that are going to be with them forever or between Christmas and New Year's.

I mean, that's what happens. Right? Right. Every year, I think the average American gains about 5 to 10 pounds between, you know, Halloween, New Year's Eve. And like, if you've been just spending all this money and effort to lose weight and you've gotten a whole new wardrobe, and I think there's a lot of stress thinking, am I gonna have to go back?

Yeah, always.

Is this gonna be one more thing that's gonna fail? And I think the good news is in the lower doses, in maintenance, it does become more affordable, which is really nice.

It does. And it's so cool because, like, a lot of the standard approaches, let's leave them on the highest dose forever. Right. And like, we have the complete opposite viewpoint of micro. Micro doses, sometimes every week, sometimes every month.

Yeah.

Are so effective.

Well, tell me this. Okay. This is what I've noticed. And when I first started working with patients on these medications, I was afraid that as they titrated up, if they got to the max dose, that that meant they could never work for them again, that they would sort of top out and whatever. But actually, what I'm seeing is that if they're making diet and lifestyle changes, they're, you know, eating the protein, the good fat. They're not. They're staying away from the carbs, healing their metabolism with the medication, that they actually can get away with smaller doses as their metabolism heals. Is that what you're saying, too?

I think so. And really the reality is, is what I don't think people understand is we have GLP resistance endogenously. Right. So, like, people with diabetes have it, people with weight gain habit, people with obesity have it. I'm sure people with thyroid issues have it, meaning we become resistant to our own internal endogenous natural glp, and that's what makes us gain weight, store fat, have cravings, not feel satiated. Well, when we actually become healthier, not just relying on this medication.

Right, right.

As we become healthier, we become more sensitive to our own GLP receptor, our own receptors become more sensitive. So of it's going to be more sensitive to an exogenous form of GLPs.

That completely makes sense. I was excited to see that because I thought, oh, gosh, what am I going to do? This patient has more weight to lose and they've reached the max dose. Yeah. It's exciting to see that you contain on a lower dose because you're. When you're more healed and you just keep going.

It is. And just cycling too. Creates opportunities, going off, taking a break.

You can take a break, get the medication out of your system, restart. There's so many ways to do this. It's a peptide, right. It's, you know, just like something that's made in our body. So.

Absolutely. Misconception number five, GLP are only for people with diabetes.

No, not anymore.

Not anymore. In fact, my favorite subset of people, at least at modern thyroid clinic, to use these medications with are for people who have a healthy lifestyle already going into it. They eat well and they already exercise and it doesn't matter what they do, they can't lose weight.

Right.

Creating hope and healing for those people is like such, like it is a sacred journey that we've been on with them.

Totally.

That elicits a feeling as like a healthcare provider that I haven't had since the early stages of thyroid. And I still get it with thyroid. Like, I mean, people cry every day. They're like, oh my God, you've changed my whole life. Right. But it's this whole new way of me pouring back into people that's so powerful. Yeah.

These are the amazing meds then. They do so much and they. Even at the small doses, I mean, and I love that we can get people early and that we're not having to wait until someone, you know, is obese or full blown diabetic, has a extremely sore joints and needs knee replacement. That we can get people in the beginning when they're just starting to see metabolic derangement and we can sort of bring them back from the brink before things really start falling off. And I love that patients can use this to lose weight, especially visceral fat. You guys, that GLP1 meds work specifically on visceral fat, which is the most dangerous, unhealthy kind of fat. Like our just subcutaneous fat is not such a problem. But it's that fat that gets marbled into our internal organs that's such a problem. And GLP1s specifically target that. And that's that kind of like middle age thickening that we tend to get right. And that is just contributing to heart disease and stroke and dementia risk. That nobody wants.

Absolutely. So, you know, FDA is sort of over time loosening more and more the regulations of insurance based prescribing of who can get these meds. Originally it was just obese people, obviously. Originally it was just diabetics. Then it's obese people, then it's people with pre diabetes who are overweight. Now a lot of studies are looking at just overweight people. But the studies that are so excited, exciting that we'll dig into in our next episode are the ones that are looking at how GLPs are influencing things outside of weight. Alzheimer's, dementia, gut dysfunction or gut function. Alcoholism, depression, anxiety.

Yeah.

I mean heart disease, obviously. Stroke risk. Kidney.

Yeah. Autoimmune conditions.

Arthritis.

Yes. Joint pain, Chronic pain in general. Seems because it just lowers inflammation. Yeah.

It's.

The studies just keep coming. It's pretty impressive. Yeah.

It's so exciting. And that is why too, I think we are not going to exit this shortage phase really anytime soon.

I don't think so either.

Right. They're just going to keep getting approved for more. Indonesia just get approved for heart disease.

I mean that's every American.

That's the number one thing that kills all of us worldwide. Everyone gets so afraid of cancer and we really need to be afraid of heart disease. I want to talk about kind of risks too.

Yes. Versus benefits and realism of what we should really be worried about. Right, right.

Let's dig into that. So like this misconception of oh, you're going to get thyroid cancer, oh, you're going to get pancreatic cancer. Oh, you're going to get gastroparesis, oh, you're going to get ozempic butt Ozempic face all of those things. Let's kind of talk through those again. Like the foundation is dose dependent, totally dose dependent.

And also it's about rapid weight loss. Right. So issues with pancreas and gallbladder can happen. If you're on a ketogenic diet and you're losing £10 in a week, that's excessively rapid weight loss. You could end up with issues with your pancreas and gallbladder. And again, if you're on too high of a dose of GLP1, you might be losing too much weight too fast. We recommend, I mean, I've heard you say optimal, probably around a pound a week at most.

Kind of.

And we know people want to have goals, they want to get there faster. That's probably, we're not probably the program for them. Right. Because we just know that's not the Healthiest way to go.

Right. And those side effects, pancreatitis puts you at risk for pancreatic cancer, gallbladder issues. That is weight loss dependent. It is not medication dependent.

You're not peptide.

No. Your risk for those things is the same whether you lose weight, restricting diet, exercise, or compare side by side if you lose that same amount of weight on a GLP1. Yeah. So let's clarify because there is so much of that talk going around. Yeah. I want to speak to specifically the, the thyroid piece of who's eligible to take these meds, who isn't, what's the risk? And because obviously thyroid is my niche, that's my thing. So when we started this program initially, we started it in modern thyroid clinic. And so we were of course, very extra cautious with our patients because they all have thyroid dysfunction. And so couple things. Research has shown there is a black box warning on these meds for thyroid cancer. That black box warning carried through and was placed and put into place because studies on rats who were on a very high dose of GLPs and have so many more GLP receptors on their actual thyroid gland, we saw an uptick in incidence of a specific thyroid cancer called medullary thyroid carcinoma, which is one of the most, if not the rarest form of thyroid cancer. It accounts for 3%. So in people specifically with a risk or with a history, I should say, of medullary thyroid carcinoma or a family history of medullary thyroid carcinoma, they should not take these medications. Does the study with rats translate to human studies?

No, we're not seeing it.

We're not seeing it. But there is a theoretical risk. Okay, so if I had medullary thyroid carcinoma, would I take a glp? Probably not. But where I think the conversation needs to shift is a couple things. One is there are clinicians, physicians, institutions, whatever, who are propagating this idea that people with thyroid conditions, people with Hashimoto's, people with nodules, people with other forms of history of thyroid cancer cannot take these medications. And that is not true. They're saying, oh, well, you have Hashimoto's, so you're at increased risk for thyroid cancer. You shouldn't take a GLP1. False. And in fact, GLP1s are reversing Hashimoto's. We are seeing it reduce antibodies every day.

It's ridiculous. Yeah. It's incredible.

Yeah.

Honestly.

Yeah. We are met like the first year and a half, maybe two years of our program. We know. Year and a half. I'D say we were collecting ultrasounds on people every three months. Yeah.

Just in case.

Just in case. Collecting data.

And there was nothing there. And I didn't know that rodents are especially prone to thyroid cancer.

So that's. I didn't know.

I didn't know. Apparently that's a thing. And apparently the rodents or the rats in the study who were the control group who didn't get semaglutide also got thyroid cancer.

Oh, my gosh, that's amazing.

I was like, okay, that's really interesting.

But.

And then there's a study showing patients on semaglutide versus patients on insulin. The ones on semaglutide had less thyroid cancer.

And being on insulin does not carry a risk for thyroid cancer. But your risk on a GLP is less than that on insulin.

But there is a higher risk if you have type 2 diabetes or obesity. Right. And these. Right. If you are dealing with obesity or 2 diabetes, your risk is already higher for pancreatitis, gallbladder issues and thyroid cancer. So it's.

It's a little bit of a confusing conversation to navigate. Yeah. And we did not see increase in nodule frequency growth. We've never had an incident of concern. So medullary thyroid carcinoma, multiple endocrine neoplasia also is an exclusion criteria of you or someone in your fa, like in your immediate family. Other than that, let's get very clear that people can take these medications with thyroid conditions full stop post thyroidectomy. I have multiple patients, specifically with a history of papillary thyroid carcinoma on these medications. I have multiple other doctors agreeing with me who are very high up in medical institutions for thyroid care, thyroid oncology, etc. So the other kind of tidbit that I wanted to add to this is, is in medicine, everything is about risk versus benefit. Totally. So what are the risks? What are the potential benefits? And I think what's happening in the mainstream media is we are talking a lot about these risks and we cycle through whichever risk we want to talk about on any given day, week. And what we're not comparing that risk to is, oh, okay, so you have a little. A little increased risk of thyroid cancer, theoretically, that's never shown up in human studies. But your chance of dying of heart disease is reduced by. I've got this statistic here somewhere.

20 to 30%.

20 to 30%. 51% reduction in cardiovascular death, which is what's going to kill more people than all cancer combined. By far. Your risk of dying from heart disease is higher. Than your chance of dying of any form of cancer all put together cumulatively. So I want you guys to digest that. So if we want to be afraid of something, it should be heart disease. And there has never been something that solves the heart disease problem like this before.

Not even close.

Not even close. Yeah. So anything to add to that? I know that was a soapbox moment.

No, I just, I've been curious if they're going to be replacing statins altogether because I, I see the destruction of statins all the time when I analyze labs like men with really low testosterone and type 2 diabetes.

Yeah.

And then they make the switch over to like a GLP one. They get their testosterone done, they get their thyroid optimized, and they are new people. Because a lot of people don't realize getting your thyroid optimized is also so good for the heart. Right. That high cholesterol, low thyroid function connection.

Absolutely. Absolutely. That is a lot of the bulk of what I wanted to talk about. But do you have any final thoughts about anything random at all that you think our listeners deserve to know or even like a big picture summary item?

I mean, if you're watching this and you're on the fence, I would just give us a call and at least attend one of our Q and A onboarding zooms because it's such a great place to learn and it's a safe space to ask your questions where you'll get like real information from experts and our clinicians because it can be really hard to know who to trust. And this is your body, this is your health journey. And I just encourage whether you work with us or not, to be sure that you pick a program that has a 360 degree program that you're not just getting the medication. Also, be careful if the price is very, very low, if it's too good to be true, there are scam medications being sold. So just be careful on that. But at least you could get information from us and see if it's a good fit and, and not feel like you're so alone in this. Because for so many people. Right. They've been at this for years and years and going from doctor to doctor and trying to get help and they're just, they're afraid to do it. They're alone. They don't feel like they can tell their family members they're thinking about doing this because of the judgment. And friends.

Right.

That's one of the things I love about our program. Right. You get in the program, you're in a community.

Yeah.

You're not alone. Maybe you're not even telling your husband you're doing it or your sister or anybody, but you got all of us. And so, I mean. Right. So I don't know. I love that we're here for you.

We are.

Yeah.

Yeah. I think my closing comment, too, just that we didn't touch on. And please tune into the next episode because we are going to be digging into absolutely, absolutely incredible information on all the benefits of these meds outside of weight loss. But I still hear people getting prescribed other weight loss meds. Like phentermine.

Oh, yeah.

That kind of thing. And I'm like, at this point, if your clinician is prescribing you phentermine, unless you have a direct contraindication.

Yeah.

To these meds, you need to find a new clinician because phentermine is compromising your health short term, isn't it? Have heart. Yes, absolutely. Yeah. Heart failure.

No, thanks.

Yeah. So you are at risk for heart failure while you're on it, hoping to lose weight so that you can improve your risk for heart disease. Meanwhile, GLPs are reducing your risk of heart disease while you are on the medication.

Immediately.

Before you even lose weight. Before you lose weight. Yeah, yeah. So, you know, rethink that. If you're right, if your doctor or clinician's stuck in 2003, it's time to move on. Yeah. Well, thanks for tuning in. We hope to see you back. Back for the next one. Yes.

Bye.