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The Neuro Experience
How GLP-1s Reduce Alzheimer’s and Cancer Risk | ft. Dr. Rocio Salas-Whalen
00:52:23
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- [00:00]
Dr. Rocio Saliswelan
We actually for the first time have a medication that will help you maintain the weight loss.
- [00:07]
Louise Nicola
Welcome to the Neuro Experience. Joining me today is Dr. Rocio Saliswelan.
- [00:12]
Podcast Sponsor/Ad Voice
A triple board certified endocrinologist, an expert.
- [00:15]
Louise Nicola
In obesity medicine and the world's expert on GLP1s.
- [00:19]
Dr. Rocio Saliswelan
We know now that weight gain, obesity is not a willpower. So having more willpower is not going to make the person lose weight.
- [00:27]
Louise Nicola
We're going to get into the reality of what these medicines can do and.
- [00:30]
Podcast Sponsor/Ad Voice
What they can't do for women in midlife.
- [00:33]
Louise Nicola
It's also got an extreme inflammatory response as well.
- [00:36]
Dr. Rocio Saliswelan
When the visceral fat starts to decrease, inflammation starts to decrease.
- [00:41]
Louise Nicola
We'll go into the effects of these medications on cancer, infertility and brain health. A cutting edge new study showed that GLP1S slashes breast cancer tumors by 20%.
- [00:52]
Dr. Rocio Saliswelan
What's one of the highest risk for breast cancer? It's not family history, it's obesity.
- [00:59]
Louise Nicola
GLP1 meds, dementia risk by 33%. That really caught my attention.
- [01:05]
Dr. Rocio Saliswelan
It leads to improvement, not just in dementia and Alzheimer's.
- [01:09]
Louise Nicola
If you go deep and deep and deep, you see at the root of it really is inflammation. Dr. Salas Whelan believes that we're going to live longer years in a healthier society because of this medication.
- [01:20]
Dr. Rocio Saliswelan
I predict that in the next few generations there will be less type 2 diabetes, if any, chronic diseases, less cancer.
- [01:28]
Louise Nicola
So you're saying that this could possibly be the end of chronic disease?
- [01:31]
Dr. Rocio Saliswelan
Yes.
- [01:32]
Louise Nicola
To me it sounds like a miracle drug. What's the future of GLP1s?
- [01:36]
Dr. Rocio Saliswelan
I think we're going to make superhumans.
- [01:39]
Louise Nicola
I'm Louise Nicola and this is the Neuro Experience. I'm so excited to get into GLP1s with you. Before we do, I want to, I want to know a background. You're so passionate about the book, right? You're so passionate about GLP1s obesity medicine. You're triple board certified, which is phenomenal. You're a triple threat. You've got this book Weightless. Let's start with why you're so passionate about it and a bit about the background.
- [02:06]
Dr. Rocio Saliswelan
I grew up in Mexico where type 2 diabetes is the third cause of death in Mexico. Pretty much everybody in Mexico has a family member that has type 2 diabetes or that has passed away from type 2 diabetes. So during medical school I was already interested in type 2 diabetes, endocrinology and more because of the lifestyle that you had to work with a patient through change in lifestyle, obesity, weight loss to get Good glucose control.
- [02:38]
Interjecting Medical Expert
Right?
- [02:38]
Dr. Rocio Saliswelan
So for me it was like the challenge to get a patient to lose weight and better glucose control. And during my training residency in 2005, I met here in my hospital where I was doing my training, which is in Jacoby Hospital in the Bronx. I met Dr. John Eng, who is the one that isolated the first GLP he wanted from the pharmacy.
- [03:01]
Louise Nicola
He tried to sell it from the pharmaceutical company and they said no, and they say no.
- [03:05]
Dr. Rocio Saliswelan
He had to mortgage his house to do the patent on the drug. But so he was invited to our internal medicine conferences at some outside Dr. Comms. And I was blown away by what he was showing us at that time. It was named Bayera. That's the first GLP1 that was FDA approved for type 2 diabetes. And this is 2005. So there it picked my interest. So my training, endocrinology. As soon as I graduated from my training, 2010, I started prescribing GLP1 to all my patients. 2010, 2010, it was Bictosa liraglutide back then, which is a daily injection for type 2 diabetes. And it was our best diabetes medication that we had apart from insulin. Right, but you're not going to start everybody on insulin. So all of our, most of our diabetes drugs cause waking on the patient. So either it improved their glucose, but there will be some weight gain. We didn't have one that actually targeted both things until the GLP1s came. So we were starting using Victoza, approved for type 2 diabetes, and patients were coming back. I remember so well, not just with better glucose control that we've never seen, but with weight loss. Okay, so off label, we started using it for weight loss independent of diabetes, because GLP1s don't cause hypoglycemia. In 2012 came the FDA approval for the first GLP1 for weight loss independent of diabetes.
- [04:38]
Louise Nicola
So when you say off label, you mean right now, is it still.
- [04:42]
Dr. Rocio Saliswelan
No, no, that was back.
- [04:43]
Louise Nicola
That was back.
- [04:44]
Dr. Rocio Saliswelan
So from 2010 to 2012, we used it off label for weight loss. 2012 FDA approval for weight loss.
- [04:51]
Louise Nicola
It's been touted as a miracle drug for everything. And this is what today's podcast is about. Because I don't want to just focus on fat loss or weight loss. I would love to talk about the mairead effects that GLP ones have, but in order to understand that, let's, let's do a crash course on what GLP1 is. Glucagon, like peptide 1. What is it?
- [05:13]
Dr. Rocio Saliswelan
It's a hormone okay. It's a hormone that is made in our small intestine, in the L cells. That is where it's secreted. And what makes it, the secretion happen is glucose, or the passage of glucose through the small intestine. So when we eat, it releases glucose, it converts into glucose, whatever we're eating passes through the small gut and it's released. We have receptors for this hormone all throughout our body.
- [05:44]
Interjecting Medical Expert
Right.
- [05:45]
Dr. Rocio Saliswelan
The first discovery was receptors in the pancreas and that's why the first indication was for type 2 diabetes, because it's stimulates the pancreas to produce more insulin in the presence of elevated glucose.
- [05:58]
Interjecting Medical Expert
Yes, Right.
- [05:59]
Dr. Rocio Saliswelan
And it also improves insulin sensitivity, hyperinsulinemia. We have receptors in our brain, in our appetite center.
- [06:06]
Interjecting Medical Expert
Right.
- [06:07]
Dr. Rocio Saliswelan
We have receptors in our gut, in our stomach, where the satiety hormones happen, where the hunger hormones happen. So that's what GLP1s are. They're a hormone where we have receptors through our body. We have receptors in our lungs, in our liver, in our kidney, in our heart.
- [06:25]
Louise Nicola
So GLP1 is a naturally produced hormone.
- [06:29]
Dr. Rocio Saliswelan
It is one fault.
- [06:31]
Interjecting Medical Expert
What?
- [06:32]
Dr. Rocio Saliswelan
Not everything can be perfect. That it's broken down within two to four minutes of its release by an enzyme, the DPP4 enzyme. This enzyme breaks it down within two to four minutes. And because of that, it's a very short life.
- [06:49]
Interjecting Medical Expert
Right.
- [06:50]
Dr. Rocio Saliswelan
GLP1 analogs, the synthetic version that we know today as Ozempe Acceptbound, they're long acting versions of our own GLP1.
- [07:02]
Louise Nicola
And is it true? Because I've put out a lot of information about this on Instagram, mainly around the link between GLP1s and Alzheimer's disease. And so I get thousands of comments, some of them good, some of them questionable. And there's a lot of upset people. Whenever I, whenever I put this on the spotlight, I feel like there's still a lot of upset people and I don't know why. And there's people saying, but we can produce it naturally. But you've just said that when we produce it naturally, it only lasts two minutes. How do we actually produce it naturally? What's it stimulated by?
- [07:32]
Dr. Rocio Saliswelan
Glucose. Food. So we eat. We eat. It's produced in our gut. It's released, it acts very quickly, but it's broken down very quickly. So all those supplements that you hear about, that to boost your own GLP1. Yes. We don't have a GLP1 deficiency.
- [07:48]
Interjecting Medical Expert
Right.
- [07:49]
Dr. Rocio Saliswelan
We don't have a lack of GLP1. It's just that the enzyme DPP4 breaks it down very quickly. We have a medication that inhibits that enzyme. They are oral anti diabetic drugs. They work well for glucose control, but never did we see the significant weight loss.
- [08:08]
Louise Nicola
It wouldn't be acting on the brain.
- [08:10]
Dr. Rocio Saliswelan
Exactly. It's still. We don't get that effect.
- [08:13]
Louise Nicola
Exactly. That's really interesting. And I'm guessing that because of the half life only being two minutes, then that doesn't have a lot of time to travel.
- [08:21]
Dr. Rocio Saliswelan
Exactly. It doesn't cross the blood brain area as well as the synthetic lung acting. And we can see that with bariatric surgery.
- [08:29]
Interjecting Medical Expert
Right.
- [08:30]
Dr. Rocio Saliswelan
So one of the reasons that patients lose significant weight quickly, yes, there's a mechanical restriction, but there's a faster production of GLP1 because they practically shorten the length from the food passing through the gut.
- [08:44]
Interjecting Medical Expert
Right.
- [08:45]
Dr. Rocio Saliswelan
Then removing a part of the stomach or a part of the gut and a bite bypass. So it's believed that there's more secretion, more rapid secretion of the GLP1, but it's not long enough to cross the blood brain barrier. So in patients post bariatric surgery, we never see the control, the central control of the appetite. We have the mechanical control, but because it doesn't cross the blood brain, it doesn't travel as fast. We don't see that foot noise reduction.
- [09:16]
Interjecting Medical Expert
Right.
- [09:16]
Dr. Rocio Saliswelan
So if you think about it, bariatric surgery, it's kind of torture. Patients still hungry, but they just cannot eat.
- [09:23]
Louise Nicola
So walk me through. So we know that there's receptors all over the body now. We know what GLP1s are, what happens when they go into the brain specifically. Let's talk about that, because what I've heard a lot of is a lot of people are reporting food noise, and the food noise has been decreased. Now I'm guessing that that is a.
- [09:41]
Dr. Rocio Saliswelan
Neural effect, a dopamine effect. So we have receptors for GLP1 hormones in our amygdala, in the hedonistic eating, drinking area of our brain, where we eat for a reward or anticipation of our reward, and it blocks that reward response. So if a person reaches for food, for comfort, for anxiety, boredom, depression, this hormone blocks that response, so the behavior changes. So let's say a person used to go for candy at night for anticipating a reward. If they're on this medication, because the behavior is there at the beginning, they reach for it, they try it, but there's no reward response anymore. So the next day they don't go for it anymore.
- [10:32]
Interjecting Medical Expert
Right.
- [10:32]
Dr. Rocio Saliswelan
So it quiets that in terms of.
- [10:35]
Louise Nicola
The body, it's also got an Extreme inflammatory response as well.
- [10:40]
Dr. Rocio Saliswelan
Yeah, let's talk about obesity, right?
- [10:43]
Louise Nicola
Let's talk about it because are we still in an obesity epidemic here in America?
- [10:47]
Dr. Rocio Saliswelan
Let's talk about obesity. What happens in obesity and obesity is basically there's higher percentage of body fat, right? There's visceral fat. Visceral fat is a pro inflammatory tissue is releasing cytokines, interleukin 6, all the pro inflammatory cells. It has our body, it puts our body in chronic inflammation. This medication reduces visceral fat by reducing your caloric intake. This is how it works. You reduce how much food you consume, but in a natural way, right? It's not you holding, it's not you being hungry and just thinking of the food. It just becomes like more controllable. When the visceral fat starts to decrease, inflammation starts to decrease. Now something that I see in patients and it happens very quickly. The patients mention that they feel less swollen even before they start losing weight. Like the first almost immediate effect within the week or two weeks of using this medication, they feel less swollen. And not significant ways has happened for us to say, oh is the decrease in the visceral fat that improved the inflammation. This medication, when you start using it, it's gonna cut your consumption of food by 50% almost immediately. It's gonna cut the consumption of usually pro inflammatory food that delivers that reward. Sugary sugar, processed food, fried food, right? So you're immediately decreasing that consumption. Many times alcohol, you decrease the consumption. So you're decreasing already pro inflammatory liquids and pro inflammatory food. So that's why the relief, the quick relief that we see in patients.
- [12:29]
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- [14:48]
Louise Nicola
For at a cafe.
- [14:49]
Podcast Sponsor/Ad Voice
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- [15:05]
Louise Nicola
Saying that they're taking a certain probiotic or a prebiotic that actually has GLP1 in it. Is that a thing?
- [15:12]
Dr. Rocio Saliswelan
If it was working, there will be shortage of that probiotic and not of semaglutide or tirzepatide.
- [15:19]
Louise Nicola
So let's talk about that because we have this huge ozempic wave and I know that's just the GLP1, but then we've got tirzepatide, which is GLP1 and GIP. And I'm guessing there's gonna be a triple threat coming up next year.
- [15:32]
Interjecting Medical Expert
Oh my God.
- [15:33]
Louise Nicola
You actually described this life cycle of GLP1s like the iPhone.
- [15:39]
Dr. Rocio Saliswelan
Yes, I liked it.
- [15:41]
Louise Nicola
At the seat of it. They all call people, they all do the same, but every year they're getting updated, they're getting better.
- [15:46]
Dr. Rocio Saliswelan
Better, safer, less side effects, more potent, more efficacious.
- [15:52]
Interjecting Medical Expert
Right?
- [15:52]
Louise Nicola
Okay, so let's talk about what's the difference between GLP1 ozempic and then the GLP1 and GIP from tirzepatide.
- [15:59]
Dr. Rocio Saliswelan
So GLP1, which is a maglutide, it's a single hormone, tirzepatide. It's a combination of two gut hormones, GLP1 and GIP. And the retatrutide is the triple agonist. And this is going to be GLP1, GIP and glucagon. So together. And they're in phase 3B so they're almost there. And the results are beyond anything that we've seen. Patients losing up to 40% body weight compared to what we see in tirceptide, which the max is 24, 25% of weight loss.
- [16:36]
Louise Nicola
But what is glucagon doing extra?
- [16:39]
Dr. Rocio Saliswelan
So glucagon itself, it produces or increases the production of glucose in the liver.
- [16:45]
Interjecting Medical Expert
Right.
- [16:45]
Dr. Rocio Saliswelan
It's really interesting that they added this hormone and they're seeing even more significant weight loss. So really the mechanism of action in regards to more weight loss is not really known in your book.
- [16:56]
Louise Nicola
So you, you've a doctor's guide to GLP1 medication, sustainable weight loss and health. You deserve. You also have a strong love for midlife women and you also are prescribing perimenopause menopause. So you're doing a lot of hormone replacement therapy, which I think right now that is being spotlighted the word estrogen and menopause. Right now we're hearing a lot about it, which is a great thing. No longer are we, we're hoping that women are no longer scared to, you know, get on this in fear of breast cancer. Let's talk about midlife and let's talk about estrogen's role in fat. And that mid area in that midsection where a lot of women are reporting to start gaining weight and they've got stubborn fat. What's happening there?
- [17:41]
Dr. Rocio Saliswelan
So after the age of 40, women gain 1 to 2 pounds per year on average. And we attribute that to the changes in estrogen.
- [17:51]
Interjecting Medical Expert
Right.
- [17:51]
Dr. Rocio Saliswelan
So we need estrogen. Estrogen is an anti inflammatory hormone, number one. But also estrogen helps to maintain our body composition with lean muscle mass and maintain our body fat in our hips, in our breast that is more protective for our fertile years. And what happens in perimenopause and menopause is that fat gets transported more centrally. We start accumulating excess fat intra abdominally and that's the visceral fat which is the pro inflammatory fat.
- [18:21]
Interjecting Medical Expert
Right.
- [18:22]
Dr. Rocio Saliswelan
That's what we call the bad fat that can lead to metabolic disease, increases your risk for cancer. It's pro inflammatory. So all of those changes while the estrogen starts to fluctuate during perimenopause can affect the body composition of women. So many times women come to my office and say this is not the way that I used to gain weight.
- [18:42]
Louise Nicola
Yeah.
- [18:42]
Dr. Rocio Saliswelan
It stops everything in the, in the center.
- [18:44]
Interjecting Medical Expert
Right.
- [18:45]
Dr. Rocio Saliswelan
So they, they, they, they know their bodies and they recognize that this is not their normal pattern or wake of waking.
- [18:51]
Louise Nicola
If a female is taking hormone replacement therapy, whether it's estrogen, progesterone, and they also want to take a GLP one, can they, they're not contraindicated against each other.
- [19:01]
Interjecting Medical Expert
No.
- [19:02]
Dr. Rocio Saliswelan
I call it the triple threat. As you mention women, I think they, they don't replace each other.
- [19:10]
Interjecting Medical Expert
Right.
- [19:10]
Dr. Rocio Saliswelan
They have different function in our body, but they are options. And I always say that both HRT, menopause hormone treatment and GLP1 should not be the last resource.
- [19:24]
Interjecting Medical Expert
Right.
- [19:25]
Dr. Rocio Saliswelan
They should be first line treatment.
- [19:27]
Louise Nicola
That's interesting. But if someone's prescribed a GLP one, are they going to be on it for the rest of their lives?
- [19:32]
Dr. Rocio Saliswelan
It's always what's the story of the individual patient that brought them to use or need a GLP1.
- [19:42]
Interjecting Medical Expert
Right.
- [19:42]
Dr. Rocio Saliswelan
Every patient has a different story. So for patients that always struggle with their weight, since childhood they've had child obesity or overweight, they've been on diet most of their life, they've been in training programs, they go to camps to lose weight. Most likely those patients will require long term treatment. Let's say a woman that never struggled with weight, pregnancy hits midlife, they have 30, 40 pounds that they cannot lose, they'll go on a GLP1. Maybe there's a possibility that they will be able to maintain on their own once they lose the weight, if they never struggle with weight. But maybe the same woman has a very strong family history of obesity. And while she was working out in her 20s and her 30s, now with the kids, not with age, starts gaining weight, has obesity, most likely that she will require also long term. But I always like to flip the coin. Using a GLP1 long term is not a failure, is not bad. It's actually we have to see it in a positive way. And this is the beauty of these medications and this is the difference of using a medical treatment and going into a crazy diet that is going to make you lose 30 pounds in four months.
- [20:59]
Interjecting Medical Expert
Right.
- [20:59]
Dr. Rocio Saliswelan
Is that we actually for the first time have a medication that will help you maintain the weight loss. Maintain is the key, maintain the weight loss. Because many things can take you there, but it's not maintainable, it's not sustainable. But for the first Time, we can offer you something that is also going to help you stay at your goal.
- [21:23]
Louise Nicola
How do you feel when people come to you and say, and this is talking like a social media perspective when they say you shouldn't get GLP1s. You can just, you know, what about willpower?
- [21:36]
Dr. Rocio Saliswelan
Yeah. I think that's very, very easy to assume when you see somebody with obesity that they have not tried to lose weight, that they have not done the legwork, that they've not seen. Doctors, nutritionists, trainers, they probably can give this person a cathedra in weight loss and diet and nutrition.
- [21:56]
Interjecting Medical Expert
Right.
- [21:56]
Dr. Rocio Saliswelan
I haven't met a single patient and I have thousands of patients through the years that came to me and said, I do nothing about my weight, I have obesity, but I'm sitting in my couch all day, I don't think about it, I'm not trying. And this is one of the reasons that I wrote my book, because it was so, so eye opening, hearing story after story of my patients doing everything that we were recommending them. They were eating less, they were counting carbs, they were counting gram so fat, they were working out cardio, spinning, you name it, they were doing everything. But it was just not working. So we know now that weight gain, obesity is not a willpower. So having more willpower is not going to make the person lose weight. It's a multifactorial disease. We have hereditary genetics.
- [22:46]
Interjecting Medical Expert
Right.
- [22:46]
Dr. Rocio Saliswelan
And that accounts to 50 to 70% of the reason somebody's going to have obesity or be overweight.
- [22:54]
Interjecting Medical Expert
Right.
- [22:55]
Dr. Rocio Saliswelan
We know the parents weight pretty conception, both mother and father is going to impact their offspring's weight in the future.
- [23:03]
Louise Nicola
Hold on.
- [23:04]
Dr. Rocio Saliswelan
Yeah.
- [23:04]
Louise Nicola
The weight you are when you are pregnant can directly affect your unborn child and how they're going to live their life.
- [23:11]
Dr. Rocio Saliswelan
It's already increasing the risk for obesity even before conception. If you start with obesity. And this is for both partners. So always my counseling for my fertile age patients that are thinking pregnancy, I always explain to them, look, this is the best for the future of your baby. The best for less complications during pregnancy and even to improve your chances of fertility.
- [23:36]
Interjecting Medical Expert
Right.
- [23:36]
Dr. Rocio Saliswelan
Is starting conception at a healthy weight. Now we have obesity that can be transgenerational.
- [23:45]
Interjecting Medical Expert
Right.
- [23:45]
Dr. Rocio Saliswelan
So, and I always do a very thorough family history on my patients. I go two, three generations above the patient and you always see a pattern of obesity. So I, I put to my patients on the table, I said, you have the possibility your grandparents, your great grandparents didn't know, your grandparents didn't know, your parents didn't know. That their weight affected your future weight. But, you know, so you can break that transgenerational hereditary of obesity.
- [24:13]
Louise Nicola
Oh my goodness, that is huge. Because then they stop passing it on.
- [24:18]
Dr. Rocio Saliswelan
Exactly.
- [24:19]
Louise Nicola
I mean, to me it sounds like, like a miracle drug.
- [24:22]
Interjecting Medical Expert
Right.
- [24:24]
Louise Nicola
But what type of scientist would I be if I didn't look at both sides of the coin? Now, when I put this out on social media, I get so many comments and we're going to go through them and maybe we can myth bust. Now, I've been told that taking a GLP one can increase your risk of getting certain types of thyroid cancer. Is this true?
- [24:44]
Dr. Rocio Saliswelan
That is not true.
- [24:45]
Louise Nicola
Why is this a thing?
- [24:47]
Dr. Rocio Saliswelan
So in the studies in the laboratory, it was found that some mice there was a higher occurrence of medullary thyroid carcinoma, which is a very specific, very aggressive and aggressive thyroid cancer.
- [25:02]
Interjecting Medical Expert
Right.
- [25:04]
Dr. Rocio Saliswelan
It was never reproduced in humans. It has not been reported in humans. Other types of cancer have not been reported in mice, less in humans.
- [25:15]
Interjecting Medical Expert
Right.
- [25:16]
Dr. Rocio Saliswelan
And somebody having history of thyroid cancer does not disqualify them to use a GLP one. And I think that's a big misconception and a myth. Except medullary thyroid carcinoma. That's pretty much our only absolute contraindication on a GLP1 is if the patient or a first degree relative has history of medullary thyroid carcinoma.
- [25:38]
Louise Nicola
But why would that be? What's the pathway there?
- [25:41]
Dr. Rocio Saliswelan
So we don't know, but we don't want to increase the risk of the patient to develop it.
- [25:45]
Interjecting Medical Expert
Right.
- [25:46]
Louise Nicola
Keeping in mind, that study was done on mice and not replicated in humans.
- [25:50]
Dr. Rocio Saliswelan
And again, we have 20 plus year data, clinical data of GLP1 medications.
- [25:57]
Podcast Sponsor/Ad Voice
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Louise Nicola
Everything I wear, especially when I go out at night.
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Louise Nicola
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- [27:52]
Louise Nicola
That's honeylove.com neuro now we have. I don't know if it was done in humans, but maybe you can talk to me about that. That GLP1s actually show a reduced risk of getting breast cancer, which I think is phenomenal. I'm going to read it here. A cutting edge new study showed that tirzepatide, which is the GLP1 and GIP, the dual drug already held for impressive weight loss, slashes breast cancer tumors by 20%.
- [28:20]
Dr. Rocio Saliswelan
And you know, it's not a surprise, that's huge. 20% and I'm gonna tell you why. What's one of the highest risk for breast cancer? It's not family history, it's obesity. Colon cancer, prostate cancer, thyroid cancer, stomach cancer. The highest risk is obesity. So if you are decreasing obesity, you're gonna decrease the risk of cancer. Remember you're going to have some anti inflammatory benefits from this drug.
- [28:51]
Interjecting Medical Expert
Right?
- [28:52]
Dr. Rocio Saliswelan
So what drives cancer? Inflammation.
- [28:55]
Interjecting Medical Expert
Right.
- [28:56]
Dr. Rocio Saliswelan
So if your immune system is concentrated in inflammation, you cannot have the appropriate response for viruses, for cancer cells. But if the inflammation is reduced, then your immune system can work and protect you.
- [29:12]
Louise Nicola
Actually when we talk about inflammation, this is probably where we see all of the GLP1s and Alzheimer's related dementia right at the seat of all of this. This is the research that I have thrown myself into over the last 10 years. We do see if you go deep and deep and deep. You see at the root of it really is inflammation as a cascade to all the other different risk factors. And what you're saying here is if we can downregulate inflammation, which is what we're all trying to do. We're all trying to do that.
- [29:40]
Interjecting Medical Expert
Right.
- [29:41]
Louise Nicola
We can minimize the risk of getting breast cancer by 20%.
- [29:45]
Dr. Rocio Saliswelan
Yes. So GLP1s are NeuroProtect on your protective neuroprotective. Also it improves insulin sensitivity in the brain, which we know, hyperinsulinemia and insulin resistant. It also drives cancer.
- [30:01]
Louise Nicola
You mentioned earlier, and I just want to go back to and know if this is the same effect you said you're seeing in a lot of your fertile females that you see that are not really in midlife, that you're getting better conception rates because of GLP1s? Is that also because obesity and insulin resistance is causing maybe be infertility?
- [30:23]
Dr. Rocio Saliswelan
Pcos, Polycystic ovarian syndrome is the number one cause of infertility in women.
- [30:27]
Interjecting Medical Expert
Right.
- [30:28]
Dr. Rocio Saliswelan
So by improving that with a GLP1, you improve the chances of conception.
- [30:33]
Interjecting Medical Expert
Right.
- [30:34]
Dr. Rocio Saliswelan
So that you hear of sempect babies is because many women that thought that conception was not an option for them, that they've tried, now they go on a GLP1, they start losing weight, no inflammation, they start having a regular cycle and boom, they're happier and they end up pregnant. Exactly.
- [30:51]
Louise Nicola
They've probably got more muscle mass, they.
- [30:53]
Dr. Rocio Saliswelan
Want to have more intercourse. You know, they feel confident mental health, and that's what happens.
- [31:00]
Louise Nicola
So, Dr. Selliswell, and I'm going to read something to you, very dear to my heart, that I posted on Instagram that went quite viral. GLP1 meds slash dementia risk by 33%. And this was a study published in JAMA Neurology in 2025. They analyzed nearly 100,000 people aged 50 years and older with type 2 diabetes who were on GLP1 medications and saw a 30% reduction in Alzheimer's disease. That really caught my attention. It really caught my attention and made me so, so happy.
- [31:35]
Dr. Rocio Saliswelan
Yeah. I mean, again, if you know the physiology of a GLP1, how they work leads to improvement, not just in dementia and Alzheimer's, chronic disease. I, I predict that in the next few generations there will be less type 2 diabetes, if any chronic diseases, less cancer.
- [31:59]
Interjecting Medical Expert
Right.
- [32:00]
Dr. Rocio Saliswelan
So this is going to be a snowball effect in health.
- [32:05]
Louise Nicola
I don't think this is a misconception. I think this is a real thing. Muscle loss. Right. So you've probably seen patients, maybe not in your clinic because you're doing it correctly, but patients who are losing so much weight that they become skinny fat. Well, what is that?
- [32:21]
Dr. Rocio Saliswelan
Great. I'm very happy that we're talking about muscle because muscle has such a positive impact in inflammation at the same level as comparing it to a negative impact from visceral fat by increasing muscle mass. Muscle is an endocrine organ. It produces hormones called myokines, which, these hormones are anti inflammatory. The most potent anti inflammatory organ in your body is muscle. So when we're talking about high risk mortality from cancer, muscle also helps.
- [33:00]
Interjecting Medical Expert
Right.
- [33:01]
Dr. Rocio Saliswelan
And muscle will help you mobility, independence, strength.
- [33:06]
Interjecting Medical Expert
Right.
- [33:06]
Dr. Rocio Saliswelan
It's not just the decrease in the inflammation, but I always say you get more, more for your buck building muscle than concentrating so much inflammation fat.
- [33:15]
Louise Nicola
And it's so hard for women to build muscle as well, and men too. But like as you move through midlife, you know.
- [33:21]
Dr. Rocio Saliswelan
Yeah. And also we have, I mean there's this idea in midlife, women especially 50s, that they think that they're going to pick up dumble and they're going to pop muscle and not, they don't want to look like that.
- [33:35]
Interjecting Medical Expert
Right.
- [33:36]
Dr. Rocio Saliswelan
But you have to, that has to be your full time job, your profession, to be a bodybuilder, to actually look like a bodybuilder. But if you go twice a week, three times a week, you won't get bulky. Right, Back to your question. Yes. So you're going to have a decreased consumption of food.
- [33:55]
Interjecting Medical Expert
Right.
- [33:56]
Dr. Rocio Saliswelan
So one of the things that people cut first whenever you are eating less, it's protein. So you're not only just consuming less amount of calories, but you're cutting your protein consumption by half or even more when you're on a GLP1.
- [34:11]
Interjecting Medical Expert
Right.
- [34:12]
Dr. Rocio Saliswelan
So, so any doctor prescriber that knows how these medications work, they always have to start the first evaluation having a talk about nutrition and talking about the importance of protein in their diet. If they're going to consume one thing while they're on a GLP one should be protein. They should be dying. Doing body compositions to see what is it that the patient is losing. Right. These are sophisticated drugs. We need sophisticated ways of, of seeing what's happening with your weight.
- [34:43]
Louise Nicola
And by assessments you're talking do a DEXA scan, for example, do a DEXA.
- [34:47]
Dr. Rocio Saliswelan
Scan, do impedance machines. Those are the most easy to have in the office.
- [34:52]
Interjecting Medical Expert
Right.
- [34:53]
Dr. Rocio Saliswelan
I mean they're very close, very close to a DEXA scan. Our gold standard is an mri, but we're not gonna do MRI on every single patient. So do some sort of body composition of, of whatever you are available. You need to measure muscle mass, percentage body fat and visceral fat. Whenever somebody is starting on a GLP1 and in fact anybody, even if you're not a GLP1, you need to know what's your body composition, how often do.
- [35:21]
Louise Nicola
You recommend looking at that if you're on it just to treat.
- [35:23]
Dr. Rocio Saliswelan
If you're on a GLP1, what I do with my patients, I do it every eight weeks. No earlier than that.
- [35:29]
Louise Nicola
Wow.
- [35:29]
Dr. Rocio Saliswelan
Yeah.
- [35:30]
Podcast Sponsor/Ad Voice
Every eight weeks, eight to 12 weeks.
- [35:31]
Dr. Rocio Saliswelan
I, I see my patients and I do a body compositions. Why? I want to see what's happening with muscle. The fat loss is going to happen.
- [35:39]
Louise Nicola
Yeah.
- [35:39]
Dr. Rocio Saliswelan
I want to know how you are maintaining muscle in this journey.
- [35:44]
Louise Nicola
So if you see what's the standard average starting dose?
- [35:48]
Dr. Rocio Saliswelan
Is it 2.5, 2.5 interceptite? 0.25 in semaglutide?
- [35:52]
Louise Nicola
Milligrams.
- [35:53]
Dr. Rocio Saliswelan
Milligrams. Yeah.
- [35:54]
Louise Nicola
Okay, great. So they take that for a certain amount of time and then if you see that they're losing too much muscle.
- [36:00]
Dr. Rocio Saliswelan
If they're in the initial dose. It's a nutrition, it's the nutrition. They didn't get the message that they need to get around 100, a minimum of 100 grams of protein a day. And many times the patient needs to see that in the body composition. So the first visit is always like the first follow up. It's a eye opening visit. If they were not doing the protein then they see that they actually lost two, three pounds of muscle and then they get it right. So there is always. I go over my patient, I say walk me through a day of protein in your diet. Walk me through a day of your food. What do you when you woke up until you go to bed? I want to know what is it that you're eating and how you're counting grams of protein. And many times the patients are overestimating or they're really getting 70 grams of protein, 60 grams of protein. And we're going to see. It's difficult.
- [36:52]
Interjecting Medical Expert
Right.
- [36:52]
Dr. Rocio Saliswelan
The $65 million question, how do you build muscle but continue to lose weight? Because to build muscle or to preserve muscle, you need to eat.
- [37:00]
Louise Nicola
I'm still ask.
- [37:02]
Dr. Rocio Saliswelan
So it's, it's getting creative in the way that you're going to be able to get the protein. The best recommendation, all of this is in my book and that's one of the reasons that I did my book is having four portions of 25 to 30 grams of protein each.
- [37:15]
Louise Nicola
And that's achievable on a GLD.
- [37:16]
Dr. Rocio Saliswelan
That's completely achievable. I have patients there on 15 milligrams, the max dose of tirzepatide and while they get four portions of protein a day they building muscle.
- [37:25]
Louise Nicola
When you said earlier on you said we're getting better with the drug every, every new one that comes out, we're going to keep getting better and better with less side effect. What are the side effects?
- [37:35]
Dr. Rocio Saliswelan
So the most common side effects. And again I'm going to talk about Ozempic because or semaglutide. Nausea, constipation. Patients feel they are on something like you're like a little bit nauseated, disgusted, you don't want to think about food, there's appetite. We don't really see that. Patients don't feel they taking a medication happens more naturally so there's less nausea, no constipation. I see usually with sep bound, no vomiting. Diarrhea can happen with either of the versions that we have with anything that is fatty or fried or heavy processed food that can give diarrhea but they're controllable.
- [38:15]
Interjecting Medical Expert
Right.
- [38:17]
Dr. Rocio Saliswelan
You can anticipate certain meals and avoid certain meals to avoid the diarrhea. It's not that you're gonna go on a JLP one and you're gonna have diarrhea.
- [38:25]
Louise Nicola
I think the best approach to taking this is not seeing it as something that's going to help you completely eliminate food. I think it's something like a companion, your personal trainer at home that's going to be there to tell you hey, you don't really need the donut. Yeah, that's fine, skip it. Have your, have your meat, have your veg.
- [38:42]
Dr. Rocio Saliswelan
In my book I mention it's your gps, right? Oh, I love that this is a journey. But GPS is Your navigation and GPS is G for GLP1, P for protein and S for strength training. Meaning. Oh, that is the prescription that anybody going on a GLP one needs to get. You need your gps otherwise you're not going to have the right results.
- [39:08]
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- [41:17]
Louise Nicola
I'm so happy you put it out there. About actually getting the GLP ones is because the kard and I think Kourtney Kardashian, who has a supplement line has got these special marketed supplements. I think they're gummies and they're GLP1 gummies. Bullshit.
- [41:32]
Interjecting Medical Expert
Right?
- [41:32]
Dr. Rocio Saliswelan
Completely.
- [41:33]
Louise Nicola
Yeah. Okay, great. I'm glad you said that. How do you feel about microdosing for a healthy individual? Let's actually talk about this because it's a real thing. And by the way, I don't know if they're doing this. Is there any black label GLP ones happening yet?
- [41:45]
Dr. Rocio Saliswelan
No.
- [41:45]
Louise Nicola
Okay, great. What's microdosing? It seems to be the new end thing.
- [41:49]
Dr. Rocio Saliswelan
Let's talk about that. Yeah, let's clear things up with microdosing. The term microdos means that you're going to be using a smaller dose for some effects than the therapeutic doses.
- [42:04]
Interjecting Medical Expert
Right.
- [42:04]
Dr. Rocio Saliswelan
Whenever a drug is studied, they study different doses and they start with the first therapeutic dose where they saw any effect of whatever the goal or the outcome was.
- [42:16]
Interjecting Medical Expert
Right.
- [42:16]
Dr. Rocio Saliswelan
So let's Say for weight loss, 2.5mg intercept appetite is the first therapeutic dose that you're going to see effect. If you go below that, well, you're not going to get the effects at a therapeutic level.
- [42:34]
Interjecting Medical Expert
Right?
- [42:35]
Dr. Rocio Saliswelan
Now if somebody tells me, well, I don't need to lose weight, I'm healthy, I just want to get all the other benefits from GLP1s, the Anti Inflammatory effects. First of all, if you don't need to lose weight, I am assuming that your body composition shows me that you have more muscle mass, your percentage body fat is in range and you have a very low visceral fat. If that is the case, I know by looking at your body composition that you are strength training that you are eating healthy.
- [43:05]
Interjecting Medical Expert
Right?
- [43:06]
Dr. Rocio Saliswelan
Otherwise you wouldn't have that body composition. So if you're doing already that you don't get extra benefits from being on a GLP1, you're already getting the benefits from muscle mass and protein in your diet and eating healthy, right? If you have a low percentage body fat, a normal visceral fat and muscle mass, that already tells me your lifestyle, you already getting all the benefits. Yeah, so many times when somebody says that and we do a body composition, surprise, surprise, your skinny fat, you have sarcopenia, obesity, your Percentage body fat is 35, is 40 and you are under muscle and, and your weight on average looks normal. Your BMI is 22.
- [43:45]
Louise Nicola
You could look good on the outside, but on the inside your organs are dying.
- [43:48]
Dr. Rocio Saliswelan
You need the full dose, right? You need to lose the percentage body fat, you need to lose the visceral fat and for that we need the therapeutic dose. So you're not really getting anything because if you don't need it for weight loss, then I'm assuming that you are in a good health. But if not, then you need the therapeutic dose to get the effects right. Microdosing can be useful in the maintenance part. Let's say somebody lost all their weight on 2.5mg on the first dose of a GLP1 of tirzepatite, then for maintenance we cannot go lower than that.
- [44:26]
Interjecting Medical Expert
Right?
- [44:26]
Dr. Rocio Saliswelan
There is the option of under dosing. I don't like to call microdosing, I like to call it underdosing. But they already are there and it's just maintenance. That's where the microdosing benefit will come in.
- [44:40]
Louise Nicola
So as long as you've got all your ducts in order, fat mass, muscle mass, non sarcopenics, you're not going to.
- [44:47]
Dr. Rocio Saliswelan
Get anything extra from using a GLP1, you're already achieving that by your body composition.
- [44:52]
Louise Nicola
Interesting.
- [44:53]
Dr. Rocio Saliswelan
Okay, but if it's the opposite, then you need the full therapeutic dose.
- [44:57]
Louise Nicola
Yeah. I can only imagine that you're probably seeing both men and women. By the way, this is for. You're probably seeing 50, 50 men coming in, seeing, saying, bringing them to tears, that you've helped them.
- [45:07]
Dr. Rocio Saliswelan
So when somebody is coming to me for the first time, most of the times it's something they want to improve, something external. They want to look a certain ways, they want to fit in certain sizes. But as we go through this journey with the gps, it flips, it becomes about strength. It becomes not about how they look, it's about how they feel. Because if you have somebody who lose 30, 40 pounds, but they lost 20% or 30% of muscle, they don't feel healthy, they don't feel strong, they feel weak, they feel tired, they start losing their hair, they start skin drying and sagging.
- [45:48]
Interjecting Medical Expert
Right?
- [45:49]
Dr. Rocio Saliswelan
We need protein for hair, we need protein for skin, for nails. So whenever a patient is losing muscle, they're losing hair. If a patient is not losing muscle and even building muscle, they're not losing hair.
- [46:03]
Louise Nicola
Interesting. Because of collagen together.
- [46:05]
Dr. Rocio Saliswelan
So if you're losing hair, you're losing hair. Muscle.
- [46:07]
Louise Nicola
What's the future of GLP1s?
- [46:10]
Dr. Rocio Saliswelan
I think we're going to make superhumans. I think for the first time, we.
- [46:14]
Louise Nicola
Have, if done correctly.
- [46:16]
Dr. Rocio Saliswelan
If done correctly, 100%.
- [46:17]
Louise Nicola
If they've got your book.
- [46:18]
Dr. Rocio Saliswelan
If they have my book, yes. Whenever somebody is going to finish reading my book, there won't be enough experience providers. But with my book, I want to have enough experience and educated patients.
- [46:31]
Interjecting Medical Expert
Right.
- [46:32]
Dr. Rocio Saliswelan
So for the first time, we're having interconnection with the fitness world. Doctors and trainers, Right. I've never referred so many patients to working out, lifting weights, to trainers as I do now in my practice with GLP1 medications.
- [46:49]
Interjecting Medical Expert
Right.
- [46:50]
Dr. Rocio Saliswelan
So the medication is gonna take care of helping you lose the body fat. And as you feel lighter, as you feel stronger, as you feel healthier.
- [47:01]
Interjecting Medical Expert
Right.
- [47:01]
Dr. Rocio Saliswelan
Mental health, once you remove the pressure of weight to exercise, it takes a different form.
- [47:08]
Interjecting Medical Expert
Right.
- [47:09]
Dr. Rocio Saliswelan
People exercise for health, for strength. It's amazing that my patients, in half of their journey, they start coming and what's my muscle? Did I lose muscle? Did I gain muscle? It flips completely. Now they want to know what's happening with their muscle. If they're building it, if they lost it, how can they regain it? So it shifts the attention completely also. So patients that don't lose muscle they can maintain the weight loss with a smaller dose or those are the ones that maybe will be able to stop the medication. For those that lose significant muscle and they don't regain the muscle, they need maintenance on very high doses of the medication. I cannot drop the drug because the drug is doing 100% of the work. But if you bring muscle into the table, it balances out and you don't require the medication at a higher dose or even, even long term.
- [48:03]
Podcast Sponsor/Ad Voice
So you're saying that this could possibly.
- [48:05]
Louise Nicola
Quite frankly be the end of chronic disease?
- [48:07]
Dr. Rocio Saliswelan
Yes. We're not going to see it in our generation, but I believe in the next second or third generation. Yes. The end of obesity, of type 2 diabetes, osteoarthritis. I mean there's endless cancer.
- [48:20]
Louise Nicola
I wonder that's insane. I wonder what the next thing is going to be after this. We've got one in phase three.
- [48:28]
Interjecting Medical Expert
Yeah.
- [48:28]
Dr. Rocio Saliswelan
B trial like it's a triple is coming out. Which the ones do you know even.
- [48:34]
Louise Nicola
After that what's going to happen?
- [48:35]
Dr. Rocio Saliswelan
The ones that are on phase three or even phase two B, we have.
- [48:39]
Podcast Sponsor/Ad Voice
A monthly injection as opposed to a.
- [48:42]
Dr. Rocio Saliswelan
Weekly as opposed to a weekly which we the what the studies are showing is a total weight loss about 15 to 16%. Again with tirzepatide we're seeing 24%.
- [48:54]
Interjecting Medical Expert
Right.
- [48:55]
Dr. Rocio Saliswelan
So less. So it will be a good option for maintenance. It may be something that somebody can take once a month for long term maintenance instead of a weekly injection.
- [49:05]
Interjecting Medical Expert
Right.
- [49:05]
Dr. Rocio Saliswelan
So that's one. Then we have a drug which is gonna be interesting to see. Novo Nordisk has a drug that inhibits muscle degradation.
- [49:18]
Louise Nicola
Myostatin.
- [49:19]
Dr. Rocio Saliswelan
Yes. And Eli Lilly has tirzepatide.
- [49:24]
Interjecting Medical Expert
Right.
- [49:25]
Dr. Rocio Saliswelan
Before Novo Northis used to have semaglutide and this antib for muscle. And they were going to do it but now in one now Eli Lilly. I'm sorry, Eli Lilly bought the muscle preserving formula. So it's going to be interesting if they combine it with tirsepatide in the future.
- [49:43]
Louise Nicola
Oh my God, that's so interesting because peptides now are becoming more abundant as well. You know there's, I think the most notable one is BPC157 which is more so to make your muscles muscles not feel sore anymore. But if it can be combined with myostatin that's going to be out of control if you think about it.
- [50:01]
Dr. Rocio Saliswelan
Also women in midlife now with hormone replacement therapy right now they're going to feel, now they're going to be sleeping well so they're going to Be more energy to exercise and better mood. And then losing the body fat with the GLP1. Now we can really concentrate on muscle and becoming strong and becoming fit.
- [50:20]
Louise Nicola
The future is female.
- [50:22]
Podcast Sponsor/Ad Voice
I think the men better watch out.
- [50:24]
Louise Nicola
Because if we have all these women.
- [50:25]
Podcast Sponsor/Ad Voice
Walking around in midlife feeling that we.
- [50:28]
Louise Nicola
Can the way they did when they were 25, I'm telling you, it's game over.
- [50:31]
Dr. Rocio Saliswelan
Let me tell you better. Better because at 25 you have no idea of anything of how your body works. I mean, it's changing. I have a lot of patience works. Yeah. So it's going to be different for them. A woman now in midlife can feel much better than what they did at 25.
- [50:47]
Louise Nicola
Before we finish, why don't you tell me when does the book come come out? When's it released?
- [50:51]
Dr. Rocio Saliswelan
So my book is going to be published here in the US and Canada in December 30th of this year. Also an audiobook and in UK, Australia, which you're from New Zealand, India and South Africa January 1st and Latin America and Spain. It's going to be mid-2026.
- [51:10]
Louise Nicola
Oh my gosh. So next year is going to be huge for you. Can we get it on pre sale yet?
- [51:14]
Dr. Rocio Saliswelan
Yes, you can pre order it in Amazon, Barnes and Noble. You can pre order my book.
- [51:19]
Louise Nicola
So we're going to put that in the show notes below. Dr. Seller swelling. You not only have educated me a lot, you show me how this scary thing you know about getting older.
- [51:30]
Interjecting Medical Expert
Right.
- [51:30]
Louise Nicola
Is it's, it's such a scary path, but it's not when you are well educated and you can go to a trusted physician like yourself who can. Who really has good intentions for people. So thank you so much for coming on the podcast.
- [51:43]
Dr. Rocio Saliswelan
Thank you, thank you so much for having. Always a pleasure. Pleasure.