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Dr. Sasha Rose and Colin Renaud, PA-C get into why a GLP-1 prescription on its own so rarely holds, and what has to sit around it for the results to last. What a GLP-1 actually is, why the weight so often comes back when the medication is the whole plan, and the pieces a fifteen minute visit skips: protein, muscle, sleep, stress, nutrient status and where a patient is in menopause. Plus live questions from the audience. Functional medicine for adults in Maine and New Hampshire.
Dr. Sasha Rose and Colin Renaud, PA-C get into why a GLP-1 prescription on its own so rarely holds, and what has to sit around it for the results to last.
They walk through what a GLP-1 actually is, why the weight so often comes back when the medication is the whole plan, and the pieces that get skipped in a fifteen minute visit: protein, muscle, sleep, stress, nutrient status, and where a patient is in perimenopause or menopause. They also take live questions from the audience.
In this episode:
Med Matrix is a functional medicine practice serving Maine and New Hampshire. Learn more at medmatrixusa.com
This episode is for educational purposes only and is not medical advice. It does not create a patient provider relationship. Always talk with your own qualified healthcare provider before starting, stopping or changing any treatment, medication or supplement.
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Well, I'm excited to be here. Today we are talking about GLP-1 medications. We're going to dive deep into kind of the benefits, the risks, what's all the buzz about and I consider you to be an expert in this topic. So why don't we start with just kind of you introducing yourself a little bit and then I'll take care of some housekeeping items before we dive in. Sure. Thanks. I'm Colin Bernard. I'm one of the lead clinicians at MedMatrix. I have a pretty unique background. I have a background in chiropractic medicine. I also have a background in natural medicine. I practice as a PA at MedMatrix and I hold multiple board certifications and I am also fellowship trained in functional medicine and anti-aging medicine. So I've been using GLP-1s I think since they sort of came out. I think they kind of boomed after COVID essentially and there's a lot of new really exciting uses for the GLP-1s that go beyond weight loss and metabolic issues. So definitely something I have been using for a while for different reasons other than metabolics and weight loss. So maybe we can dive into that too. But tell us a little bit about yourself, Dr. Rose. Yeah. My name is Dr. Sasha Rose. I am a naturopathic doctor licensed acupuncturist. I sit on the Forbes Health Advisory Board. I've been practicing functional medicine for going on 21 years now and I'm one of the lead providers here at MedMatrix and am using the GLP-1 medications on a daily basis and honestly it's like probably one of the most amazing. They are one of the most amazing tools that I've come across in my 21 years. So I'm super excited and yeah, just want to also make sure that our listeners realize that everything that is discussed today is for educational purposes only. We are not providing medical advice. If you are interested in becoming one of our patients, you are more than welcome to go to our website and book a discovery call if you're interested to see if you are a good fit. The other thing to mention is that if you have questions, I know my current patients, I know a lot of people just in my life in general have a lot of questions about GLP-1 medications, you can use the comment section and we are going to do some Q&A at the end. Again, no direct medical advice, still educational, but we do love questions. We do love to know that you're here. So definitely chime in at the end. You can put your questions in any time. We will get to them at the end. So Colin, let's get going. So I'll just give a little bit, I mean I think a lot of our listeners know a lot about this because GLP-1s are kind of talked about so much, but I'll just do kind of a brief overview and then you can kind of help us dive into what they are exactly. So we know that GLP-1 medications have become one of the most talked about topics in healthcare. People often know of them in terms of their ability to support weight loss and improve blood sugar. We are also seeing benefits in terms of appetite and you already mentioned metabolism, some metabolic concerns, but I think because there's so much out there right now on social media, in the news, a lot of commercial brands out there, there's a lot of confusion. I know I have patients coming in often confused about what they actually are, how they work, what's the safety when it comes to them. So today we're really looking at GLP-1 therapy from a functional medicine perspective and we're going to kind of talk about semaglutide, terzapatide, people have sometimes heard those terms but they're kind of strange so we'll get into that. And then even some of the emerging ones like retitutide. So hoping that we can talk today about differences between conventional prescribing and personalized dosing, who may benefit from a GLP-1 therapy program, what the risks are and why we believe that kind of long-term success is more than just being handed a medication. So that's kind of what we are hoping to kind of cover today. So why don't you start us out with what exactly are GLP-1 medications? Sure. GLP-1, what exactly they are, is an interesting question because a lot of people just know the name, like GLP-1, it's actually something that naturally occurs in the body. A GLP-1 stands for glucagon-like peptide 1 and it is a naturally occurring hormone that's produced actually in the gut. And essentially the peptide, and that's the other thing, a lot of people don't know what's a peptide. Because we talk about peptides all the time and we've done tons of podcasts on peptides and we use peptides all the time at MedMatrix, but GLP-1 is actually also a peptide. At its core, GLP-1s help regulate your blood sugar and they help with appetite, they help with insulin release, and they help with digestion. So basically what the medication is designed to do is mimic the body's natural GLP-1 response. So the medication was originally developed for type 2 diabetes management, it's been widely utilized for weight loss and weight management, but there are some new really exciting emerging fields of GLP-1s being studied in complex chronic illness, and you mentioned some of the different types of GLP-1s, Dr. Rose, like terzapatide, there's some new studies about how anti-inflammatory it is. So there's a lot of emerging, exciting things that are going on with GLP-1s and their utilization, and they've become such a major topic, as you mentioned. I think the biggest reason why they've become such a rising topic is because of the rate of obesity and metabolic disease has significantly increased. You made a great point when you were introducing this to say, is this really appropriate as part of a program? I think that's a huge point that we need to make about GLP-1s, is that when you come to MedMatrix, I will speak for all of us as clinicians, is if your chief concern is weight loss, you're not just going to be put on a GLP-1 and like, okay, bye, see you in a year. That's not the way we do things. GLP-1 is a tool that we utilize as part of a big, broad-spectrum treatment plan of lots of other things that need to be optimized, but we are seeing it much more commonplace because of the rise of obesity and metabolic disease, and that's really what it was developed for, so people are using it. You can get some pretty significant weight loss results, that's what the clinical studies have shown, and there's just such a huge increase in media awareness, public awareness. I can't watch any of my streaming services without a commercial for the new GLP-1 pill or whatever, so there's such a growing demand. Are you seeing anything different, Dr. Rose? What are your thoughts? Have I missed anything at all? I do think it's important because we kind of throw this terminology around just to talk a little bit about the evolution and maybe some of the differences with the GLP-1s. I mentioned semaglutide, and semaglutide mimics one hormone, so it's an agonist to the GLP-1 hormone, or another way to put it is that it's basically kind of fits in the same receptor as that GLP-1 hormone that we produce naturally, so that was kind of the first generation. That's ozempic for people that don't know. Exactly, so people will sometimes say to me, what do you mean the GLP-1s, do you mean like the ozempic? Yes, the commercial brand is ozempic, or wagobe, and so terzepatide is an agonist for two different hormones, GLP-1 and GIP, so that one works on two hormonal pathways, and the commercial version of terzepatide is Menjaro or ZepBound. There's also now an oral semaglutide, the commercial of that is Rebelsis, am I pronouncing that correctly? Rebelsis, that's how I say it. Rebelsis, yep, so that's the oral semaglutide. Again, this is just kind of terminology, and then the one that is still being studied, but I know is out there on social media, is retitrutide, and that's kind of like a third generation or next generation being studied for GLP-1, GIP, and glucagon pathways, so not one, not two, but three, mimicking three of those hormonal pathways, so again, with each generation of these medications, the scientists, the researchers are trying to affect additional metabolic pathways. Anything you want to add to that? I'm so glad you said that, because I think it's really important to define all these things, because a lot of my patients will come and, you know, my doctor put me on Ozempic, but I see terzepatide, or like my best friends on terzepatide should be on that instead, like what's the difference? So there's definitely an evolution of these, you know, Ozempic was really the beginning of where we started, and we're evolving, the drugs are evolving, the understanding of what you're doing is evolving, and as you very eloquently said, they are able to use the drugs in different ways now because they're affecting different receptors, so the way I sort of explain it is when we use, say, terzepatide, which is that second generation, the GLP-1 and the GIP, it might work better for certain people because of two receptor targets versus, say, one, which is what Ozempic does, maybe potential for less side effects or a different outcome, or as I said a few minutes ago, terzepatide is being studied at micro doses or very small doses for different other types of, like, inflammatory diseases, immune-mediated diseases, so there's a lot of different nuances with this, and we don't certainly want to confuse people, but it's really important to make these definitions aware for, you know, make people aware of the definitions, I think it's really important, so. Absolutely, yep. Yeah, and I think it's important that we kind of, oh, go ahead. No, you go ahead, finish your thought. No, I was going to say I think it's important, you know, for us to kind of talk about why this matters. Yep. You know, like, why do we care? Right, right. You know, why do we care about all this kind of thing? So how do you answer that? How do you answer why they've become such a major conversation, why people kind of, you know, why they're kind of not going away, the GLP-1 medication? Yeah, well, it's not going away because, like I said, there's such an influx of obesity and metabolic disease in mainstream, or in the mainstream media, that's how it's being advertised, but there is a huge shift in American culture anyway that a lot of people have obesity or metabolic disease. And the other thing, too, I'll be kind of honest and say is that GLP-1s, they're a bit lucrative. You know, there's a cost factor there, so there's a lot of new things popping up online and, like, all telemedicine companies where you can kind of, you know, sign up with somebody, but I don't love those because you're not getting a lot of personalized care. So there's a lot of stuff in the media, but they are really important because they are used as a tool for people to, and what I try to explain to people is to kind of get started, you know, to kind of get the ball rolling. You know, we talk about diet, we talk about hormones, we talk about nutritional deficiencies, we do all this work in our patients, but sometimes the way I explain it to people is we just need something to kind of get you feeling a little bit better, get the weight loss started, and then that's how people start to evolve in, say, a weight loss journey or a metabolic journey. And a lot of people struggle with, you know, food noise, which we should talk about, right, cravings of food and relationships with food, and when you use the medications appropriately, I've seen people have completely changed relationships with food during the process, where they don't crave certain things, you know, their craving for sweets or bad food goes away, which is huge, right? If you can change the relationship that you have with food, I mean, that's really amazing. So, yeah, I think that's one of the main reasons why this is really important. And what are your thoughts, Dr. Rose? Why do we care? I think it's a really good point to bring up about food noise and what we, you know, I think, as we mentioned, the GLP-1s were originally designed for diabetes, and then we saw that people were losing weight, and they're now seeing these benefits that were not part of the original intention, that was not part of the original design. And, you know, we're going to get into this in a little bit more, but about how, you know, especially Teroseptide and maybe Retetrutide lower inflammation, and then separate from that, we know that they, you know, in terms of that food noise, there's an impact on brain chemistry, not just kind of stomach chemistry, and it's really about satiety and appetite and how that's both the brain and the gut, and somehow these GLP-1 agonists kind of work in both the brain and the gut, and so it's, you know, hormonal and neurological, and it's not just about willpower. And so they're, because of that brain chemistry, they're like investigating using the GLP-1s for all sorts of addictive behavior, for different substance abuse, and that's where that brain chemistry, we're not just talking about food anymore, right? We're just talking about addiction, essentially. So I just find that to be fascinating, and before we move on, I just want to say, because I know there's some people that have just joined, so just to kind of get everybody on board, we are talking about GLP-1s, if you haven't picked up on that already, the benefits, the risks, and kind of why all the buzz. Around weight loss and GLP-1 agonists. Just to say it again, we are here for educational purposes only, not medical advice. If you have questions, please put those in the comments section. We are going to get to that at the end, and thank you for being here. So we were talking about food noise. So do you feel like GLP-1 medications really are only about weight loss? No, definitely not. And you brought up the point a minute ago about inflammation, and a lot of patients that I see, I know you see too, and just all of us providers at MedMatrix, we see a lot of, we see not a lot, but we'll get patients where there's a lot of complexity. You know, there's autoimmune conditions, or different inflammatory conditions, or multi-system conditions that are inflammatory, whether it's like a mass lactivation syndrome, or a rheumatological issue, or people that have had chronic fatigue syndrome, or Lyme disease, or something like that. And we start to ask the question, you know, all of these complex chronic illnesses have a stem of inflammation. And if we can use something like a GLP-1, specifically the trizepatide, that second generation, because it's been shown to be highly anti-inflammatory, if we can use this type of tool to reduce systemic inflammation that may affect someone's whole body, that could be a huge stepping stone in their health journey. GLP-1s at micro doses, so very small doses, have been studied for, as you said, addiction, mass lactivation syndrome, autoimmune disease, chronic fatigue syndrome. So it sort of begs the question, like, are GLP-1s the answer to complex chronic illness? Or potentially, like, is that part of it? And it might be. I've used the GLP-1s, like I said, for years now to treat very complex, you know, immune deficiency, and MCAS, and POTS, and post-Lyme. I'm going to stop you for a second. Can you define those for our listeners, please? Most people might not know what MCAS or POTS stand for. Mass lactivation syndrome, postural orthostatic tachycardia syndrome, chronic Lyme, chronic fatigue syndrome. So people that are struggling with a lot of these, like I said, chronic inflammatory states, the GLP-1 might not necessarily be like the, okay, here, and just goodbye. You know, there's a lot of work that we have to do. But if we could use, say, something like a GLP-1 as a tool to reduce inflammation and potentially get people feeling a lot better when they felt really bad for a while with whatever they're dealing with, that's a huge win. And I'm seeing such amazing progress with some patients in these complex illness populations where we're using it as a tool. So I do use it for weight loss. I know you do, too, in metabolic syndrome, in prediabetes, diabetes, helping with blood sugar management. But you mentioned the addiction piece, you know, in complex illness. It's starting to ever so much evolve. There's studies that are being done currently on GLP-1's effect on long COVID, or sort of like long hauler COVID, whatever you want to call it, where people are getting sick from getting COVID. Like after it gets better, they're just chronically sick after COVID. There's a lot of big studies being done on it. So I think we're going to start to see this a lot more in other realms, not just diabetes or weight management. So yeah, it's a huge, huge thing. Are there other things you're seeing, Dr. Rose, did I miss anything? Just to kind of go over a little bit of some of the metabolic pieces, I think. Two days ago, I did a podcast on insulin resistance. And so insulin resistance is a great example of what can sometimes be part of the root cause of weight gain and metabolic dysfunction. And so oftentimes, a GLP-1 medication can be a really helpful part of working with that. As we've kind of mentioned, and as you and I both love to talk about, is kind of hormonal changes, hormonal imbalance, thyroid dysfunction, kind of all of these things that can kind of go into metabolic dysfunction. Like those are some of the things that we see our patients coming to us with, complaining about, again, those really intense cravings, weight that they can't get rid of, we've mentioned the blood sugar thing a couple times, definitely that like abdominal fat, belly fat, feeling really fatigued after you eat, like those are all kind of signs and symptoms when there is metabolic dysfunction. And then what we see, we'll get into this again, going forward, but on some of the labs, we'll see things like non-alcoholic fatty liver. Again, those are all aspects of metabolic dysfunction. And those are some other symptom pictures, symptom pictures that we might see where potentially a GLP-1 can be part of a comprehensive plan. Talk to me about, well, why don't we talk a little bit more about the weight piece and like why sometimes weight gain isn't just weight gain and maybe when you're with a new patient and they are talking about weighing more than they would like and you're looking at, you know, the metrics that we use, which is we use like the in-body scan and you're looking at it and you know that this person is carrying more weight than they should. What are you doing? What are you looking at in terms of root cause for that weight gain? Because I know that you, I've worked with you long enough, I know that you're not just handing out medications. In the telehealth places where that's basically what it is. And I know that's not what you're doing and I know it's not what any of the providers here are doing. So how are you looking at weight gain, you know, before suggesting a treatment plan that may include a GLP-1 agonist medication? Yeah, so really, what is the root cause of weight gain really and how are we assessing it from a functional medicine perspective is very broad. And I don't speak for all of us providers at MedMatrix because we all have, we've worked together very closely. We all have very similar sort of philosophies on this, but weight gain is very multifactorial, right? You don't have weight gain because you have a terzapatide deficiency, right? That's not how that works. So that's why, as you said, and you're 100% right, if patients come to me and say, oh, I have weight, you know, as my primary concern, I'm overweight. Oh, well, here's a GLP-1, I'll see you in a year. Nope, that's not what we do. Weight gain is highly multifactorial from hormonal dysfunction to very poor diet. That's probably number one is poor diet, poor lifestyle, sleep, being off, chronic stress, nutritional deficiencies, gut issues. So those are the things that we assess at every new patient visit is, okay, I'm overweight, help me. Okay, well, number one, what are your weight loss goals? So I can sort of understand what that looks like. You know, is it a hundred pounds? Is it five pounds? Everybody's definition of obesity for themselves is different. And then let's talk about you, right? What are you eating every day? What are you drinking? How much alcohol do you drink? How much do you sleep? How much stress do you have? You know, let's take a look at your hormone health. Are you perimetopausal? Are you metapausal? Or a female? There are so many metrics to this. And like I said, I think what we do really well, or what I try to do, and I know you do too, like you said, we've worked very closely together for long enough now. We know each other to say that if some of these basic things are not being met, and we've talked about this ad nauseum on this podcast, if we are not meeting some of the basics of diet, lifestyle, alcohol, sleeping, you know, all this stuff, you've got to do that. So the GLP-1 is not just, okay, here you go, have a happy life. It is, okay, you want to lose 100 pounds? Great. We could use the GLP-1 as a tool. I'm happy to do that with you, but you have to meet me halfway. You have to do the work. We have to change your diet. We have to change the way you're doing things. I will meet you halfway with the medication, and I will also guide you how you're doing things. We have to optimize your protein levels. We have to make sure you're not snacking. We have to make sure that you're not drinking 30 alcoholic drinks a week. We have to make sure you're sleeping. All of these things are so, so important, and that's really where people succeed, and I think that's where MedMatrix succeeds as a clinic and us as providers is we do so much hand-holding with patients, and I don't mean that in a negative way. I mean it in a way to guide these online companies that offer GLP-1s where they just give you the drug and there's no support. They're not talking about diet. They're not talking about your nutritional deficiencies. They're not addressing menopause. They're not addressing your eating habits. They're not addressing your sleep, and maybe the GLP-1 will work a little bit for a little while, but you'll run into a roadblock, and so many of my patients are those people. They'll come to me and say, yeah, I was on it. I managed my lifestyle and my diet, but no one's telling me how, so that's what we do really well here at MedMatrix, and that's really how I start the conversation of GLP-1s. It is a very multifaceted approach with a lot of different variables. It's a total life change. You want to lose weight, you have to be ready for a life change, so it's not just being put on medication. Yeah. How do you approach this, Dr. Rose? Yeah. I think it's a good point to make that it's not just a medication, and it's how and in what context it's being recommended, at what dosing, et cetera, and I know that, and again, at Nauseam on this podcast, we've talked about kind of conventional medicine versus functional medicine, but what I'm seeing is that when a provider within conventional medicine is prescribing a GLP-1 medication, as we've talked about, their hands are tied, mostly because of insurance coverage and some limitations in terms of relationships or ties to big pharma, so usually if somebody is prescribed a GLP-1, they have to basically have a certain BMI, they have to have a certain blood sugar status, and their insurance may or may not cover it, and there's also commercial medication guidelines, so they're very limited in kind of the amount that they're being given at what titration they're being given, and so there's very standard dosing and escalation schedules, and that's, you know, even if the conventional provider does have more awareness or more information about the nuances of GLP-1 medications, they are limited, and so one strength, I think, to the conventional approach is that there is, you know, there is real strong clinical research for obesity and for type 2 diabetes, there's very clear prescribing guidelines, and people are often, you know, losing weight and improving blood sugar, and so I don't want to make it sound like there's not great things happening kind of within with GLP-1s and conventional medicine, would you agree with that? Totally, yeah. I mean, there are really great things happening in both worlds, I just think we do it better. Is that okay to say that? Well, let's be brutally honest, yeah. That's kind of mean, but no shade, but like I said, I think we just, we have so much more ability and time to utilize the medication as a tool, I think that's how it was intended, it's not just a set it and forget it, right, it's not a crock pot, you put it on and just like, okay, leave it there for a while, you have to do the work with the patient because metabolic disease is a lifestyle problem, it's a, you know, type 2 diabetes is a lifestyle problem, and if you are in the conventional medical setting treating it just as any other pathology and just medicating it, A, you're not teaching the patient anything about how they got there, and B, what we're trying to do is instill change in the patient long term, if you just set it and forget it and don't give guidance, how is that creating a new perspective for the patient on how they're supposed to treat their health, treat their body, understand what their body does, understand how their health is important and active health care is so important, right, this isn't just passive where we give you something and you don't have to do anything, health care is active on the part of the patient and our philosophy at MedMatrix and just as a functional medicine provider, the philosophies of functional medicine is looking at all the parameters and really instilling active health care in the patient so they can understand what it is they need to do to change, change to get their goals that they're looking for, so it definitely plays a lot of roles and it, you know, conventional medicine does well, MedMatrix just, if there's not a lot of guidance, it probably isn't doing as well as it could, I think that's really the take home for that from my perspective. Absolutely, yep, and I think we've touched on this a little bit but, you know, one of the biggest differences is I think our ability to really personalize the dosing like which GLP-1 medication and what is the, you know, how we can really personalize the pace of the titration, the personalized dosing, why don't you talk a little bit more about what we mean when we say, because I use the term microdosing with my patients all the time, tell us kind of what that means and how you're adjusting things and a little bit more maybe with, you know, how you might use a GLP-1 medication with somebody with mass cell activation syndrome versus the person who does need to lose weight. So, as you said a few moments ago, Dr. Rose, about how conventional prescribing guidelines sort of dictate the care of these drugs and that's very true. The drugs are prescribed at very specific doses. So, if people are familiar with the GLP-1s that you would say get from a commercial pharmacy, a big box pharmacy, they come in an autoinjector pen mostly where you just set the dose on the little dial on the skin and hit the button. With the GLP-1s as a drug though, there's a lot of potential benefit of the drug at various doses that are not those standard doses that have been laid out for type 2 diabetes and obesity. So, I won't give numbers because I don't want anybody to take these numbers and run with it, but if let's say Terzapatide, the type 2, the second generation GLP-1 is being used at certain incremental doses for obesity. It starts at this dose and it can go up to that one and that one and that one and that's how some people might progress in an obesity situation. We could use Terzapatide as a microdose, sometimes like a tenth of the starting dose of the Terzapatide for weight loss for someone say with Mass Electivation Syndrome or some sort of inflammatory, multi-system inflammatory condition. At the micro doses, these very small doses, often less than a milligram, they've been highly studied as being extremely anti-inflammatory. So, we're not using it to, like you said, shed 70 pounds. We're using it for full systemic anti-inflammatory benefits. The Terzapatide molecule, the GLP-1 molecule, has also been highly studied as, for example, a mass cell stabilizer. So, it can stabilize this part of your immune system to be more functional and not as dysfunctional, inflammatory, reactive. So, as a very, I guess as you called me, I don't want to call myself an expert, but I am very well versed in the GLP-1s for a lot of different things from metabolic disease, diabetes, obesity, to these complex chronic illnesses. The ability to utilize them in various ways is very grand. So, when we are talking to patients, when I'm talking to patients as a clinician at MedMatrix and I'm saying, okay, what are our goals? That's so important because it will tailor what we're going to do. If we were to rely on a Terzapatide, say, at a standard dose, we wouldn't get those, the ability to do that treatment at a bit of an altered dosing schedule so that we can get some of those other benefits. And the thing I want to make it very clear is that these things are being highly studied, too. We're not sort of making this up. This is not information or kind of winging it. Dr. Rose and I are not winging it. These are protocols and dose schedules that have been highly studied. Microdosing has been highly studied for various conditions that we're speaking of. So, this isn't like a MedMatrix thing, although we do it really well. So, you can come to MedMatrix for us to do it, but this isn't something we made up out of thin air. These drugs are being highly researched in these different arenas and microdosing protocols and other complex disease besides diabetes. So, definitely really interesting. Absolutely. The other piece, when we're trying to kind of fill out for somebody what it might look like, like in what context and what might kind of prompt us to consider GLP-1 therapy, I think it's also important to consider the amount of labs that we do when we are kind of evaluating, determining if this is the right medication for somebody. And so, that's going to include markers that are pretty much all included on our initial comprehensive lab panel, and that's a fasting glucose or fasting blood sugar, fasting insulin, a hemoglobin A1c, which is a three-month average of your blood sugar, a lipid or cholesterol panel, liver enzymes, a full thyroid panel, multiple inflammatory markers, nutrient levels, hormones, kidney function, and then, as I mentioned earlier, the in-body scan, which gives us a really great picture, full metrics about body composition. So, all of these are basically, in addition to what we've learned about medication in the health history, markers that help us determine if this is one of the goals to lose fat, to change body composition, to preserve muscle, to improve metabolic health, or as Colin articulately put it, more about these other kind of long-term inflammatory conditions. And so, just to give our listeners, our viewers a little bit of a perspective that we're always including in our test results, in our assessment. Talk to me a little bit about muscle preservation, and I know that is a concern with kind of, in general, when we are considering GLP-1 therapy. So, give our listeners a little bit of a context in terms of muscle preservation. Yeah, muscle preservation and GLP-1s are such an important discussion point to be made together. We talk about muscle preservation with GLP-1s with every single patient because it is very well known that there is a potential for muscle loss with GLP-1s, all of them. Not just ozempic, not just terzepatide, but all of them can have some amount of muscle wasting. So, when we talk about muscle wasting, we're talking about it in the sense of preservation. There is a certain amount of risk of that. So, the thing that we have to do is we have to talk about the diet, right? Again, something your conventional doctor, your primary care doctor, may know nothing about or may not even address. And I've asked the question and my patients, yeah, no, they don't tell me anything about that. Or again, some of these sort of online companies that are prescribing the GLP-1s and there's no guidance, they're not talking about it. So, one of the most important things is protein awareness. Being adequate with protein amounts is really important in the diet. So, again, as I mentioned earlier, if we're not talking about that, you're not getting the drug. I'm not prescribing it to you if you're not going to meet me halfway and say, yes, I'm going to work on my diet with you. Great. You have to do it. It's like a must because we have to make sure we're doing this the healthy way. We're not trying to cause chemical anorexia. We're not trying to lose 50 pounds in a month. None of that's healthy. We're trying to do this in a very sensible, healthy, logistical way so that you're getting the results you want and we're keeping you healthy along the way. So, muscle preservation is one of the most important things we discuss. But protein in relation to that is the biggest thing. So, we calculate, you mentioned BMI, the BMI before, how much body mass you have, but we also measure something called basal metabolic rate or BMR, which is like how many calories you burn just from laying around on the couch all day. We need to know that. We need to make sure you're eating enough. We need to make sure you're eating enough protein to match how much weight you are, how many pounds you weigh should equate in some way to how many grams of protein you should eat. And that's all very personalized care. We can't just spit out a number because everybody's different. So, that's all part of the discussion from the very beginning that I have with my patients about what this drug really means in terms of other parameters that we have to deal with. So, the muscle wasting is a big one for sure. Yeah. One thing I do, I am seeing that. So, this is how I'm talking about it. And this is based on some research that I, a couple different studies that I came across because I had that concern. My patients had that concern about muscle preservation when being on a GLP-1. And what I learned from these studies is that, and I do feel like I'm seeing this clinically as well, is that when somebody is on a GLP-1 medication for weight loss, like this is an individual who needs to lose say 30 to 100 pounds, we're going to see muscle loss. We're going to see it initially. And what the studies have shown is that the muscle that's lost initially when it's kind of that much that has to be lost is actually not healthy muscle. It's striated with fat. And so, what the studies show is that kind of until you get closer to the ideal weight for that individual, it's kind of okay to lose that muscle. Now, that doesn't mean that they're not focusing on protein and that they're not kind of aware of it. But when you get closer to that goal weight, it should plateau. Like the muscle loss should plateau. And I also have just a caveat that when we are say microdosing, that's kind of a different picture. Like I'm not seeing the same degree of muscle loss because I don't think it needs to happen. And it's kind of... So, that same principle applies, protein, et cetera, like make sure that you're doing strength training and doing the things to kind of maintain muscle. But we're just not also seeing that degree of muscle loss. So, just a kind of a clinical note and the research that I came across when I was concerned about it. That's a great point. Yeah, yeah. So, let's kind of come back to MedMatrix. Like when somebody comes to MedMatrix and they're curious about GLP-1 therapy, their cousin was on it, did well initially, but then this cousin's insurance got taken away. She had to go off of it overnight. She gained all the weight back. This patient coming to us thinks they might want it, but that story with the cousin kind of freaked them out. Like how does the process begin? So, yeah, the process begins at MedMatrix if you are interested in say a GLP-1 for weight loss or you're just interested in weight loss in general. So, at MedMatrix, we use obviously a functional medicine model to healthcare. That's what we do. That's what we've been talking about. That's what we talk about on this podcast. And basically, we're evaluating interconnected systems that affect weight and metabolism. So, if that's really what the goal is, right, we're using this for weight loss. We'll make it a little bit simple. We are identifying potential root causes and contributing factors to why a patient has obesity at a certain level. We're looking beyond just like symptoms. Like, okay, I'm overweight. Okay, well, why? You know, we are trying to create personalized roadmaps really for care. We're trying to create an understanding of various aspects of a patient's health so they can put it all together for themselves so they can understand that the reason why obesity is their problem is not just, again, a trizepatide deficiency. It's not a thing. So, we're using this medication as a tool, but we're trying, as I said, to create this roadmap of care so that they can understand really what it is they need to do to change, where diet comes in, how their lifestyle is affected, are there hormone deficiencies, are there nutritional deficiencies, stress management, sleep management, and sleep hygiene. All of these things are extremely important. So, the MedMatrix evaluation of a patient really starts from the initial visit, where, as you talked about and you've listed all these different labs that we do, that's from day one. You have those lab values drawn in our office before you even meet with us. And then, when you meet with us for the first time, we'll talk through all of these metrics with you. We'll get a really good comprehensive health history out of you, and we will then talk about all of your labs, and we'll talk about all the things that need to be done over a 3-, 6-, 12-month period so that you can attain the goals that you're looking for, and whether that does include a GLP-1 or not, that's part of the conversation. And the big part of the conversation is, okay, is this appropriate for you? What are the risks? What are the benefits? What should you expect? How do we use this? How is it used over a course of time? What should you expect as certain outcomes? That's all part of our initial assessment. It's a lot of information, but it is extremely important for us as clinicians to give all this information so patients understand what it is they're doing as part of our method of healthcare. Did I miss anything, Dr. Rose? Is there any...? No, I think you hit it. I think the biggest take-home, hopefully, is individualized care, individualized dosing, and I think we've talked about that initial visit, and I think often here's one place where we split from conventional medicine and GLP-1 therapy is the ongoing support. So we do labs in general every three months. Every time you come in for your labs, we're getting you on that in-body so we can kind of track the body composition. We're supporting you in so many ways, whether it's lifestyle, whether it's adjusting the dose of the medication. So it's not... That support, that ongoing support, I think is just as important as that initial conversation. Yeah. So one more piece on this, then I want to get into the question and answers, and then I want to finish with kind of what our take-home is for this episode. So what would you... Again, you've run somebody through kind of a program. You've been seeing them for six months, nine months. What would success look like from kind of a MedMatrix perspective in relation to this topic? Yeah. So in relation to a GLP-1 program, success in that program at MedMatrix really is, as you said a few moments ago, personalized plan. A personalized nutrition plan. We're talking about your calories. We're talking about your protein intake. We're talking about resistance training, exercise, muscle preservation, sleep optimization, stress management. I mean, we're not therapists, but I sometimes feel like one sometimes during our visits, right? Yeah. Sometimes patients need that, right? I just need to vent. I need to talk. We have got stuff going on. It's like, okay, totally fine. We are providing, which I think we do an amazing job as clinicians here in the clinic, is we provide ongoing monitoring and support for people. And I've seen, we're going to get to in a few minutes, but in some of the comments that people are leaving us on our socials is they don't know how to get started where people are saying, I want to do this, but you have to tell me exactly what to do. Well, that's what we do. That's 100% what we do. And that's what we pride ourselves on and say, listen, this is all the objectives. These are your goals. This is exactly what you're going to do. You're going to do X, Y, and Z over the next three to six months. We're going to do A, B, C, and D. After that, you're going to combine it with LMNOP at this point in time. So... I don't know about that medication. Tell me about that one. It's focusing on this sustainable metabolic health journey rather than just short-term weight loss. We're not trying to lose 50 pounds in a month so you can go to a wedding or whatever. It is really trying to introduce the idea of a sustainable life change over a course of time, and weight loss is the journey. We're using this as a place to create a new life for a person. Because if they're looking, like we talked about, 70 pounds, 100 pound weight loss, that's a whole different life that a person has to live. And they're often looking to live and we just have to get them started. So that's really what we're doing. That's the MedMatrix perspective. And I think we do it really well because we have a lot of happy patients. I think it's an important topic that we've discussed today and I think it helps people feel validated and people feel excited about it. It's exciting for us. Absolutely. It's really exciting. It is. I agree. So we're going to dive into some Q&A. It looks like our first question is asking, how many different things do you test for? Do you want to take that one on? You listed a whole bunch. I did earlier. I don't know the number. So it's something like the initial panel is like 100 biomarkers. And that's just the initial panel. The initial panel is over 100 biomarkers and we talked about inflammatory markers, thyroid markers, immune system markers, hormones, vitamins, all kinds of biomarkers that help guide your care. And we also do a lot more testing than just that. We do a lot of specialized testing. We do a lot of gut testing or testing for Lyme disease or mold or other more complex things. But every patient gets over 100 biomarkers as a new patient for us to guide the care initially. It's a lot of information and it's a really good starting place for our care. Yep. What is the difference between ozempic and terzepatide? I have heard that terzepatide is better. Why would my doctor recommend ozempic and not terzepatide? Do you want me to answer this one? Yeah, go for it. So as Dr. Rose talked about at the beginning of the podcast, ozempic is also known as semaglutide. It's the first generation, first out of the gate GLP-1. It is a GLP-1 only receptor medication. Terzepatide, also known as ZepBound, also known as Munjaro, has multiple receptors that it's acting on, GLP-1 and something also called GIP. So it's sort of like a second generation to the GLP-1 world. I typically use terzepatide over semaglutide or ozempic. Typically, in my experience, there's less side effects and it's been more heavily studied in the microdosing world that we talked a little bit about. So why a practitioner might recommend ozempic and not terzepatide, that's really hard to say. They might just be comfortable with using ozempic as like a clinician preference. They just know how to dose better. They know what to expect. For me as a clinician, I do prefer terzepatide. But again, clinicians have their own set of experience as to why they might do something. So why they might do something versus say another person getting similar treatment, it's not that one is right or wrong. It's just different in opinions or different circumstances. And if you do have questions, you can ask your doctor. Like, why are you giving me this versus terzepatide? It's a really reasonable question. And if they don't give you a good answer, then maybe you need a different doctor. I don't know. There may be, if this is through insurance, there may be insurance reasons as well. That's a great point. Yeah, insurance reasons. Your insurance plan may cover ozempic but not terzepatide. Great point, yeah. Which GLP is the best brand? We kind of were talking about that a little bit earlier. But there's a couple of questions here about oral administration versus injection. So my experience with this is that we have a lot more kind of research and just us clinically with kind of the injectable forms. But we are now seeing oral semaglutide is available. And I know of one family member who is doing well on oral semaglutide. I have started to prescribe it, but I don't have – it's been recent enough that I, in all honesty, I can't tell you how it's going. I can't give you like an actual real-life clinical feedback in terms of how people are doing results-wise on that versus the injectable forms. What about you, Colin? Yeah, I agree. The oral just hasn't been around long enough, so we don't have a lot of clinical experience. At least I don't. And that's really one of the tenets of evidence-based healthcare is what the research shows and then what the clinician's experience really is with prescribing said intervention. We don't have the ability to alter the dose with the oral option. So if we're trying to use the GLP-1 in a microdose formulation for something other than, say, metabolic disease or type 2 diabetes or obesity, the oral is just a standard. And it's just not something that I know enough about yet. I agree with you. There's just not enough data, I think, yet. But the oral might be cheaper, maybe more accessible, but it's still semaglutide, right? So is that preferred over terzapotide? Well, it depends on the patient. So there's a lot of variables here with why one might be better than another. And like I said, this is really where we're excelling, I think, at this with MedMatrix, is we can really dive into all these questions for a patient rather than just kind of like, okay, try something random and see if it works. Exactly, exactly. I think we have time for one more. All right. How do you get my bowels to work daily with terzapotide? Is there a supplement that would help versus taking Miralax? I think you and I both have some, again, without giving direct medical advice, some general information around digestive health. I want to talk a little bit briefly about the most common side effects on the GLP1s, which I think we maybe need to just say one more time, and then I'll let you kind of get into what some of your favorites are. But we do know that with terzapotide, the most common side effects do affect the digestive system. So that's going to be nausea and constipation for most people. I have had a couple patients with other GI symptoms, but those are definitely the most common. It's probably a given that the higher the dose, the higher the risk of some of these side effects. And, as always, everybody is very different in terms of their sensitivity. So, yes, it is something that I talk to everybody about before suggesting it. And, Colin, what are some of your favorite, in general, suggestions around optimizing gut health while using a GLP1? I mean, one of the things that I worry about if a patient is having significant GI disturbance is if the dose is not right. Maybe the dose is too high or if there is inadequate nutrition. If there's not enough calories in the day, if there's not enough protein in the day, it can significantly affect the symptoms in the bowels. Also, time of day kind of matters, too. I usually recommend patients do their injections at night. So if they're having some nausea, they'll sleep through it. But a lot of times, if there's a lot of bowel disturbance, something is probably not right. Something needs to be changed about the medication. And it's not just, well, put other supplements to mask that symptom. That's not really a good answer. We really need to have the patient not be so symptomatic. Something's a little off. I think something needs to be adjusted. Yeah, we're not trying to put something over another problem. That's not a great idea. Like a Miralax or another laxative. Yeah. Which is a great example of how we offer support and personalized care. Right. Right. So for anybody listening who is curious, just for the purposes of time, these questions are amazing. I wish we had time to answer all of them. Unfortunately, we don't. We do have to wrap up. But I'm so glad that there is the level of engagement that there has been. So if somebody is curious about GLP-1 therapy, Colin, what do you feel is kind of the most important takeaway? Yeah, so GLP-1s, like I've said before, are really valuable tools for the right patient. They're not necessarily for everybody, and they're not necessarily for everybody at the right time. Right? Could it be right for you now and not later or vice versa? Yes. And they are not magic solutions. They're not. Right. I've said this a few times. Obesity is not a terse appetite deficiency. Right. That's not the way this works. So long-term success with weight loss or metabolic health change is really addressing nutrition. It's talking about exercise. It's talking about sleep. It's talking about hormones, stress, metabolic dysfunction, and really root cause medicine. And that's what we do really well at MedMatrix is identify root causes of things. So the ultimate goal, like I've said before, is lasting health and not just weight loss. I think that's, like, the biggest takeaway I can offer when it comes to GLP-1s. Absolutely. Yeah. I completely agree. Unfortunately, we're out of time today. But I really thank you, Colin, for being here, as always. So enjoy the conversation. It's been fun. And I want to thank our viewers for joining us and engaging and for being kind of motivated in optimizing your health and just wanting to educate yourselves. I just think there's nothing more important than that. And just the fact that you're here is kind of evidence of that. So really, really happy with the level of engagement and the interest. So if you want to send this to a friend, a family member, if you want to listen to this again, find the podcast later. You can find it on Spotify, on YouTube. You can find it on Apple Podcasts. And if you are interested in becoming a patient, if you're not already, you can go to our website, which is medmatrixusa.com. You can book a discovery call and, again, see if you are the right fit and see if we can help support you in your health journey. So fun to be here. Any other final things, Colin, before we wrap it up? I think we did great. Yeah. One final thing is just if you're interested in being a patient, you have to be in Maine or New Hampshire. That's a little bit of a caveat, Maine or New Hampshire only. No, I enjoyed the conversation. I hope people got something out of this, and I hope it is food for thought for people that are maybe on a weight loss journey or on a GLP-1 journey to ask questions of their practitioners, ask questions of your doctors. Are we doing this? Are we doing that? You haven't talked to me about my diet. You haven't talked to me about my protein. Ask the questions of your doctors. They're supposed to help you with these things. So that's my advice of the day. That's great. But thank you, Dr. Rose, for the conversation. Thank you. It was always very fun. All right. Have a good night, everybody. Goodbye.