← The Tamsen Show
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- [00:00]
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Today'S podcast is sponsored by midi health i walked in with real symptoms brain fog exhaustion anxiety and walked out with nothing but a suggestion to wait it out that's why midi matters they actually listen and they treat what others ignore this is midlife care that finally makes sense ready to feel your best and write your second act script visit joinmitty dot com tamsen today to book your personalized insurance covered virtual visit that's joinmitty dot com tamson midi the care women deserve okay tam fam you know that sleep is my number one priority i mean it it is the thing i focus on all the time and trust me when my sleep is off everybody feels it everybody in my life so i have to share what i've been using because it's made such a difference for me it's called the eight sleep pod five it's a smart mattress cover that goes right on top of your existing bed it's designed to help you sleep deeper and wake up feeling more restored and what i noticed first was how it regulates my temperature all through the night i like it cool aira likes it warm and somehow we both get exactly what we want the pod learns your sleep patterns and adjusts automatically so you're not waking up to throw the blankets on and off your leg back and forth you know what i'm talking about if you know you know then there's the data when i wake up i can see how i slept sleep stages horror heart rate breathing all of it this holiday season eight sleep is extending their biggest sale of the year use my code tamsen at eightsleep dot com tamsen for up to four hundred dollars off the pod five you even get thirty days to try it risk free plus eight sleep products are now fsa and hsa eligible financing options such as affirm are now available have glp one s been studied enough can you clear that up for us we.
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Have data since the early nineteen eighties when it was first discovered clin we have twenty years of clinical experience and data of this medication being safe doctor.
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Rocio salas whelan is a powerhouse in endocrinology a glp one pioneer a trusted voice in metabolic health and the doctor who has helped thousands finally understand their bodies without shame today she's answering your questions all i hear about is microdosing glp one s what does that even mean and is it recommended i've heard glp one s can help with pcos is that true and how is there anything we can do to combat the side effects i feel like everyone's complaining about nausea i'm in perimenopause and really struggling with belly fat that won't go away right now is it cheating to.
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Use a glp one we shame patients for gaining weight we shame patients for not losing weight on their own and now we're going to shame them for using a treatment for a medication to help them lose weight.
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Glp one s should you go on them what are the long term risks are they worth it there's so many questions out there but i'll be honest i've been just as curious as you because they are everywhere so this week we are doing something different i've asked you to send in every single question you can think of and you have delivered hundreds of questions have come in and today we're getting the questions answered by one of the best in the field doctor rocio salas whalen is a board certified endocrinologist and obesity specialist she sees patients every day in her new york city practice and her new book weightless comes out december thirtieth this book and today's conversation will be your roadmap i guarantee it but not just to losing weight to understanding your body in a way that most of us were really never taught in today's q and a we're gonna get into everything for you we're gonna talk safety we're gonna talk hormones side effects pcos menopause maintenance you name it we are gonna cover it today so if you've been curious or skeptical or you're just kind of tired of all the noise online please stay with me because by the end of this episode you're gonna finally have real answers before we jump in though a tiny favor leave a quick review or rating i read every single one of them i so appreciate it and it's the best way to help us keep growing this community doctor rocio thank you so much for being here we put the ask out for questions and i thought we're gonna go get a couple of them trickling in and they flooded our inbox so are you ready for today i.
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Am ready shoot them at me first.
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A
Of all i want to talk about the book because this feels like the book so many of us have been waiting for a roadmap a guide an understanding of what glp one s really are and what they can do so what pushed you to write the book.
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B
Several things one is learning what i learned through my patients more than what i learned in medical school or in my training was hearing my patients coming to me and hearing their stories about obesity and their weight so i felt like everybody need to hear that not just me and second i saw a huge need of really experience guidance on using a glp one the science of glp one s are moving faster than we're training doctors right and what i've seen through my plus sixteen years of prescribing glp one s is that when they're done the right way their results.
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Are great and not just weight weight.
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Loss it's not just weight loss it's overall holistic improvement of their health and in my book with the title weightless it's a metaphor of what i see in my practice i see my patients coming to me initially for a physical idea of them losing weight but throughout their journey what i see is that they don't only lose physical weight they lose trauma they lose years for some decades of guilt and shame so they become lighter every time not just physically but mentally spiritually emotionally so they become.
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Weightless i don't think people realize that like you lose trauma how does that.
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Happen and this is one of the reasons why i wrote my book because as doctors we were trained and some doctors still do of the calories in calories out and that's how you're going to lose weight you want to lose weight eat less exercise more come back later in your appointment you didn't lose weight try harder eat even less exercise even harder and that was the story and what happened is that patients were not losing weight because that's not the answer and we stopped having the conversation and then we just dedicated ourselves to treat the consequences of obesity because for that we do have treatment right and.
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A
People felt judged people felt like they there was something wrong with them because they couldn't lose weight is that right.
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B
Yeah and they lost the trust of doctors unfortunately so they wouldn't open up to us and when i opened my private practice that i was able to sit with my patients for at least one hour is where i started hearing their stories and that they were actually doing everything we were recommending them they were eating less they were exercising more i got taught off diets that i've never heard in my life by patients and for many patients obesity or being conscious about their weight started in childhood so i may see them in their fifties and their sixties so they've spent decades trying to get to that point on their own you start the book.
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A
With an apology to patients that is really powerful why did you feel like.
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You needed to apologize because we failed them and because they were actually listening to us and we attribute it to non compliance we attribute it to not being smart enough not trying hard enough not really wanting to lose weight and what i've learned is that patients have been doing every single thing that we were telling them and it was not happening they were not losing weight because now we know and now we understand that obesity is not a willpower problem it's not just controlling how much you eat and how much you exercise it's far more complicated i think that bears.
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Repeating it is not just willpower it.
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Is not just willpower and that's why i wanted to start my book validating the struggle and the effort that patients were actually putting and we were not seeing it we were not believing it we were not asking about it what's.
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The biggest misconception if there is one that you want to set the record straight on with glp one s that.
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They can be used as a supplement as something that you can use temporary i think we have to remember that it's a medication right it's a drug that has benefits and it has side effects and glp one medications were designed to treat long term chronic diseases such as type two diabetes and such as obesity meaning chronic disease we don't cure we control so for somebody who let's say has type two diabetes we start them on a medication we improve their glucose we don't stop the drug just because the glucose improve the glucose improve because you're on the drug so very similar concept with obesity now not everybody falls in one same identical box every patient is an individual their story of their weight may be different but for the majority of patients these are supposed to be long term drugs that's very.
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Confusing because i think some people say like okay i'm gonna get on it i'll lose weight and then i'll i don't need it anymore and then what happens does the weight come back the.
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Easiest way for me to simplify it is going to depend the reason that brought you to need this medication to begin with so if i have a patient in their fifties and their sixties and they started with struggling weight at eight at nine at ten and they remember pat remember the first time that they were conscious about their weight either by a comment of their mother or their father or their friends in school or by a doctor they remember when they were started on the first diet so if i have a patient they have decades of struggling with their weight most likely they will need the medication long term now i'm going to use myself as an example as a different type of scenario so i had kids very late in my life almost in my forties and then after i gave birth of my second child i entered perimenopause so i was in my mid forties carrying forty extra pounds never before i had struggled with weight i was very physically active and in my family i don't have history of obesity or overweight but i couldn't lose the weight because i was in a different scenario in my life my hormones were not helping me i had two toddlers under two at the same time so i used the medication for six months and i was able to stay off of.
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It since then but that wasn't something you were dealing with no it was just until something specific happened exact it.
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Could be somebody going through surgery and they have surgery and they're gonna gain weight and maybe they struggle after to lose the weight then that's a temporary use of the medication can you sum.
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Up exactly what glp one does so.
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Glp one is a hormone that we make in our gut and what this hormone does or what it was first discovered to do was it stimulates the pancreas to produce more insulin when your glucose goes up in your blood so so its effects are glucose dependent meaning there has to be food for it to act as a diabetic drug your glucose has to be elevated to truly act as a diabetic drug meaning if you don't have diabetes it won't drop your sugar further than what is normal it doesn't cause hypoglycemia in regards to weight loss or how it works is it targets the two reasons we eat we eat for survival and then we eat for anticipation of our reward either from food or beverages the survival of feeling better as a anticipation either for if you have anxiety and you emotionally eat or for depression for boredom or you're anticipating a feedback of that specific food or beverage and this medication it decreases your hunger hormones it increases your satiety hormones so that takes care of like the survival part of eating and then for the reward part of eating we have receptors of this hormone in our amygdala where is the hedonistic eating and drinking area of our brain and it just blocks any response or any reward that you were getting from food let's say if somebody is already thinking of having a glass of wine when they get home because they're anticipating that they're going to get relaxed that's a reward right you're anticipating a reward so this medication i think we all learned.
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That during the pandemic actually right exactly.
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We really did and there was a lot of increase of obesity and weight gain during the pandemic because of that reason and so that's how this medication works it changes your behavior how you view food you eat for when you're hungry you still enjoy your food but then once you're full and you'll get fuller faster because of the medication then you're not thinking of food in between meals or anticipating certain reward from food.
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I think it's fascinating so we asked for questions again we got flooded with them do you mind if we do a audience q and a for the rest of this episode because i think it's going to cover a lot of things everybody wants to know but i figure if anybody's up for it you're up for it totally this one i put up at the top because i think it's the one that we got over and over again when we went down the list have glp one s been studied enough can you clear that.
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Up for us yes they have so.
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Is this a question you get constantly.
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B
You know less and less okay that's i think it's less and less so the message is getting through they are not new drugs they not suddenly happen after ozempic right and we had some celebrities talk about it with we have been using them for type two diabetes since two thousand five they were the.
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First two thousand five the first twenty.
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Years that's twenty years clinically available but studied it goes even in the nineteen eighties nineteen nineties right so we have of data since the early nineteen eighties when it was first discovered but clinically we have twenty years of clinical experience and data of this medication being safe.
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A
I mean that's real those are real numbers there's a lot of things that haven't been tested that much would you say exactly exactly there's ozempic wegovy manjaro and zepbound are they all the same.
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B
With different names they're in the same umbrella of medications but but they're just different versions of them i like to compare them like the iphones right we have the iphone x the iphone fourteen the iphone seventeen same concept same use but every time they come improved with less bugs more battery life same thing can be thought of the medication so each version is safer less side effects and more effective in regards to weight.
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Loss is there one in particular that you lean toward or it just depends.
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On what somebody needs it depends on what the insurance will cover many times what the patient has access economically for the medication but if in a perfect world i would use tirzepatide which is sepan or mounjaro but next year we're having other new versions of it all.
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Right so this question that i'm gonna ask came from sarah she asks who should be prescribing this a lot of companies are popping up and i don't.
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Know where to start yes and that's scary because of course they're going to prey in people that are desperate to get this medication right and the access to the medication ideally i'm gonna go by tiers number one tier is an obesity board certified physician that's what you are that's what i am second tier is an endocrinologist which i'm also an endocrinologist and then third will be more primary care which i am too primary care internal medicine family medicine other specialt that have interest in prescribing the medication physician assistants nurse practitioners right right now we need the more the more the merrier in prescribing this medication responsibly what does that mean it means that you need to have the knowledge of how these medications work you need to know that what we're looking for when we prescribe this drug is body recomposition we're not chasing a number in the scale or chasing to improve a bmi for sophisticated medications like the glp one we need responsible use of these medications because really if somebody's prescribing this drug they can leave the patient more worse than when they started how so if they only concentrate on the number on the scale by this number on the scale dropping and specifically if they're happy that patient is losing significant rapid weight loss most likely what's happening is they're losing muscle mass they're not really losing what they need to lose which is percentage body fat and visceral fat so we're making the patient sarcopenic obesity so having low muscle mass is even more dangerous than having high body fat so if you have somebody who's coming with high body fat normal muscle mass you put them on this medication but you don't follow their body composition they're going to be losing both right and at the end the patient is going to still be with more body fat than muscle.
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Mass and that's somebody that is educated with this understands it is following up.
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A huge red flag if they're not doing body composition getting on a machine.
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Testing how else do you do it i know i've done one on a.
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Machine the gold standard is an mri which we don't do generally right the second best is a dexa scan and there's many many clinics and offices that they offer dexa scan for significantly economic price or an embody or one of those scales where you hold your the handles and there's an electric current going through your soles of your feet and it separates fat water and muscle are.
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There knockoffs to these drugs or something that people should be watching out for.
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Which always scares me unfortunately yes there have been found knockoffs i mean if you not if you're not obtaining your prescription in a regular commercial pharmacy then you should be questioning where is it produced if it's a real medication so cvs walgreens target any pharmacy where you commercially get your prescriptions that's going to be your safest bet also buying it through their pharmaceuticals website through novo nordisk or through lilly direct then we know it's coming from the manufacturer right but if you're leaving your office with the medication and is most likely a compounded drug we physicians normally don't sell branded fda approved medications in our offices they go to a commercial pharmacy how are.
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A
The prices in terms of accessibility because that is these have been very pricey.
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Is that correct you know through time the price is getting better but still expensive for the majority of people that need them currently for today no nobody should be paying full price for this medication nobody should be paying the one thousand one hundred dollars to one thousand two hundred dollars per month of this medication both pharmaceuticals have manufacturing coupons that were applied then it cuts the cost to half and then through their direct pharmacies it's even less expensive price and recently president trump obtained a deal or reached a deal with both pharmaceuticals novo nordisk and eli lilly to sell the medications at an even more accessible price which that is huge and so that.
- [19:54]
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Makes it more accessible for people the only concern you have is making sure.
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There'S the doctors correct exactly so we're going to have a very high demand and high use of these medications as they become more economically accessible but we don't have the manpower in regards to healthcare to really guide this amount of patients because obesity is an epidemic and we have a very small we're already physician short shortage in the country but even more specialized doctors for using these medications is even less and that's another reason why i wrote my book is because i wanted to be that bridge between the patient and between somebody who is prescribing the medication but not maybe doesn't have the knowledge how to guide the patient properly so it's my clinical expertise in a book and what i did in this book and this was the most difficult part was was writing in a language that was both understandable for people for patients and also for physicians because i get approached a lot if i can give courses or master classes or mentor people in my clinic so i figured to do it in a way that for somebody who wants to prescribe this medication the right way this is a beneficial use of the book for somebody who's thinking of being on a glp one currently on a glp one reach their goal on the glp one this is also an important book because it's going to guide them from beginning till end.
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A
Hey i gotta ask you something do you have a tough time giving gifts because i really really do every year around this time i want to give gifts that feel thoughtful pieces that people will wear again something that doesn't just disappear into a drawer guess what i've discovered a secret quince it makes it so simple this season pieces that have quiet luxury and feel beautiful the moment you touch the them mongolian cashmere sweaters italian wool coats everything looks beautiful the prices make sense quince does cover everyone on your list cashmere sweaters that are fifty dollars and feel like something you'd find in a high end store silk tops wool coats they're the ones i keep coming back to over and over they're tailored beautifully feel soft and substantial in a way that lasts through the years everything's crafted with premium materials and ethical factories you can see the care on the stitching the drape the fitting fit these are the pieces that people love and can be worn on repeat and for me personally cashmere has been my personal go to it feels soft structured and their cashmere has held up through travel and really long work days they make great gifts although sometimes i like to keep one or two for myself find gifts so good you want to keep them with quince go to quince dot com tamsen for free shipping on your order and three hundred sixty five day return returns now available in canada too that's q dash u dash i dash n dash c dash e dot com tamsen for free shipping and three hundred and sixty five day returns quince dot com tamsen every year i tell myself i'm going to be one of those people who breezes through the holidays totally in control and then the travel the gifts the dinners and the hosting it all hits at once and it's so easy to lose track of what you're spending isn't it i mean especially when you're not looking at everything all in one place place if you want to keep your finances under control this holiday season you need to be using monarch rated wall street journal's best budgeting app of twenty twenty five monarch is the all in one personal finance tool that brings your entire financial life together in one clean interface on your laptop or your phone and right now just for our listeners monarch is offering fifty percent off your first year when i link my accounts i can actually see how fast the holiday spending adds up oh my goodness it was really a wake up call monarch though helped me adjust before the credit card bill showed up now i check my holiday spending category look at my year end to do's and i finally can go into the new year without all that financial hangover monarch organizes everything retirement accounts investments savings you never have to touch a spreadsheet again oh i love that don't let financial opportunities slip through the cracks use code tamsen at monarch dot com in your browser for half off your first year year that's fifty percent off your first year at monarch dot com with code tamsen so this book is to help any physicians out there that might be listening to understand understand in a way that they're more educated about being able to prescribe or at least have the conversation and for real people out there like all of us who are not doctors that can understand this so you're going into a doctor with a roadmap or if you've been prescribed a glp one you can follow and do the best you can do on it is.
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That right exactly and that's a one hundred percent perfect description because patients also have responsibility and i find that when patients are educated in what they're treating what they're taking in their disease we work together better and the results are even better for the patient because there's.
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A
More to do than just take your pill you've got to eat i mean take your shot you've got to eat the right way you've got to monitor.
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Things you have to maintain the patient's biggest homework is maintaining their muscle mass and that's not an easy feat this.
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A
Next question it feels like there's always a new one coming out is there one coming out soon that we should.
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B
Wait for yes retatrutrite is called what.
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A
Is it called reta trutite reta trutite.
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Okay correct you said it better than.
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That why can't they make those names.
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Easier no so that's a triple agonist so osempe wegovi is a single glp one tirzepatite is dual agonist so it has glp one and gip and then retatrutide which is coming twenty twenty six is a triple it has glp one gip and glucag so the studies show they're currently on phase three they show significant more weight loss than we've seen so far with what we have available wow that's a very exciting one to come then we have the oral wegovy which is oral semaglutide by novo nordisk at a much higher dose than we have available right now for type two diabetes that's coming out that is coming out probably end of this year oral semaglutide oral wegovy and then next year i mean there's so many coming out in the future one also that i think is going to be great is a monthly injection maritide is called and this is going to be once a month injection of a glp one and what i see that being used for is maybe adolescents that don't want to inject themselves or every week an injection and also for maintenance if we can maintain somebody on a once a month injection i think the concept of long term maintenance with the medication is going to be more acceptable what is the.
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A
Difference between an injection and oral oral.
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B
Glp one is that you take it it's a pill that you're gonna take every day and the injection is a subcutaneous injection right so i think there's gonna be use for both of them i think the oral medication is gonna be really good for children and adolescents that may need this medication because it's approved for ten years and above for type two diabetes and twelve years and above for obesity and overweight elise is.
- [27:09]
A
Asking this question how fast are you supposed to increase the dose i keep hearing g but what does that actually.
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B
Mean for semaglutide which is ozempic and wegovy the first dose which is zero point two five milligram that is designed to be done for one month only we won't see much weight loss after a month and this dose is more it was designed more to help you tolerate higher doses where we start seeing.
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The weight loss that means you're not going to the bathroom or feeling nauseous.
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Or stomach exactly so that's semaglutide osempic and wegovy tirzepatide the first dose is a therapeutic so we can see significant weight loss on the first dose so for tirzepatide which is mounjaro and sep bound a patient can be up to three months in the first dose or reach their goal on their first dose it depends on how the patient is tolerating how fast we're going to move it depends how much they're losing or not losing right so no patient is alike and every patient may have a different journey of period of moving their.
- [28:12]
A
Medication all i hear about is microdosing glp one s what does that even mean and is it recommended i feel like i wrote that question even though i didn't because microdosing is confusing to.
- [28:23]
B
My head microdosing what the concept what the word means is that we're gonna use a micro of a dose that we have available so a much smaller dose of what we have available so microdosing a glp one would mean using a dose lower than zero point two five milligrams in semaglutide or sempegwecoby or lower than two point five milligram which is sepount and mounjaro tirzepatide so using lower doses in that now the current doses that we have are the doses that were studied that was seen effect the desired effect either glucose control for patients with type two diabetes or weight loss for patients that are overweight or have obesity those are the therapeutic doses those doses were studied to see result when we're talking to using underdosing or smaller doses of microdosing then we won't expect the desired results that the drugs were desired for now that's the science of it the concept outside of people making in this of let's i want to microdose just to get a trend exactly of that is because people are saying i want to get all the benefits of a glp one i don't necessarily need to lose weight but i want the anti inflammatory effects i want all of those effects that people are taught talking about when they go on a glp one but the point here is if you are saying you don't need the weight loss effect so meaning you want to use a lower dose because you're not looking for weight loss we need to do a body composition to say that you don't really need to lose weight okay only showing me or you knowing that your body composition shows higher skeletal muscle higher muscle mass lower visceral fat lowest percentage body fat that means that you don't need the medication to lose weight that's a true statement if you already have a great body composition you're already getting all the benefits that somebody will get from a glp one by losing weight right there's no added benefits exercising having a healthy body composition so why would somebody microdose still matters because most likely those person that are microdosing and saying well i feel much better most likely they did need to lose lose body fat okay.
- [30:40]
A
If you don't totally change your diet does it still work or is it just because you're eating less the answer.
- [30:46]
B
Is no it won't work the same if you keep eating the same and number one you will feel terrible by eating the same and taking the medication fatty food fried food highly processed food is going to give you diarrhea okay so you're going to be struggling with diarrhea if you plan to keep eating the same type of food second you're gonna lose muscle mass by eating the same amount of food and when you lose muscle you slow down your metabolism muscle is really the most important one of the most important organs that we have in our body it's an anti inflammatory organ it produces hormones called myokines and these are the most potent anti inflammatory substances that we have in our body if you lose muscle you lose that anti inflammatory effect and now you're pro in a pro chronic inflammatory state.
- [31:34]
A
And explain what an inflammatory state does.
- [31:37]
B
So we have inflammation in our body body is acute inflammation and chronic inflammation acute inflammation is when you cut yourself you scrap your skin you have a cold something acute is happening in your body and your immune system is going and attacking it and protecting you chronic inflammation is when your body is in a constant protection from your immune system visceral fat drives inflammation so if you have high visceral fat you're putting your body in chronic inflammation what happens and this was the perfect example was covid covid came patients with obesity were the ones getting more severely and dangerously sick more icu stays and higher mortality we knew that patients with obesity were in chronic inflammation but we hadn't had something like that that would come out of nowhere and showed us that you don't need to wait years to have severe effects from that chronic inflammation came this virus and people with high higher mortality so when your body is in chronic inflammation it's leaving the doors to anything come in in your body including tumor cells to grow including infections including this virus covid right so if you have your body in chronic inflammation your immune system is preoccupied fighting the that chronic.
- [33:03]
A
Inflammation do glp one s really help with inflammation would it help with frozen.
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B
Shoulder the anti inflammatory effect of glp one s is direct and an indirect and this is patients that go on a glp one they say within the first week they feel less inflamed less swollen they already feel the effect because in the first week you are already cutting by half what you normally would eat and not only that it's decreasing your reward or your reward type of foods which tend to be salt salt sugar processed food fried food those are mostly an alcohol right so all of those are pro inflammatory food so in week one you're eating half of what you normally would eat in amount and you're also craving less the sugar than the salt and the fat so that already you have an anti inflammatory effect just by decreasing what we are eating so that tells you how a pro inflammatory diet we have right and then second as patient starts to lose visceral fat hopefully gaining muscle mass then that decreases inflammation too and also there are some receptors of glp one that have a direct anti inflammatory effect but are we going to use glp one like we use ibuprofen advil no okay who.
- [34:16]
A
Are glp one s not safe for.
- [34:18]
B
Is there anybody very very short list of contraindications one is if a person has themselves been diagnosed with medullary thyroid carcinoma which is a rare aggressive type of thyroid cancer and also if they were diagnosed with men multiple endocrine neoplasia that's also very rare and i would say patients with anorexia not all eating disorders it helps with patients with binge eating and bulimia but anorexia nervosa it will be very cautious to to use.
- [34:53]
A
This medication priya asked i'm in perimenopause and really struggling with belly fat that won't go away right now is it cheating to use a glp one no isn't it amazing the shame that's involved with so many things you know also.
- [35:07]
B
That i see as we shame patients for gaining weight we shame patients for not losing weight on their own and now we're going to shame them for using a treatment for a medication to help them lose weight so there's no they cannot get a break patients and they deserve a break so no you're not cheating and in midlife especially perimenopause and menopause your hormones your current life status of the stresses that come with midlife aging parents or losing our parents or children growing up going to college professionally are our peak we're not sleeping because of hormones because of stress everything in our surrounding is really pushing us to gain weight in midlife and make it harder for us to lose weight so very common i hear patients saying i'm doing exactly what i was doing in my late thirties mid thirties it's not happening or i'm doing even more and it's not happening all right this.
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A
Next question i'm on hrt will glp one s help or mess with my.
- [36:11]
B
Hormones they won't interact in a negative or beneficial way there was one study that showed that patients on hrt tend to lose more weight on a glp one than those not on hormones but what is more of a causation than a direct effect because women on hormones will be sleeping better they will have more energy their mood will may be better also right than not being on hormones so there's no direct correlation that estrogen will help the glp one work better or vice versa it's more that it's giving the woman the right tools to lead a healthy life lifestyle when you are on a hormone replacement therapy because your quality of life for the majority of patients improves okay this question.
- [36:57]
A
Came from jillian i have hashimoto's will glp one s actually help with my symptoms or make them worse it would.
- [37:03]
B
Not affect directly hashimoto's and autoimmune disease.
- [37:08]
A
Yeah can we explain what hashimoto's is.
- [37:09]
B
Hashimoto is an autoimmune disease that can cause or lead to hypothyroidism which is an underactive thyroid hashimoto means that you have antibodies against your own thyroid that with time it destroys it and then you need hormone replacement which is levothyroxine for example right if your body is in a chronic inflammatory state is leaving the doors open for autoimmune diseases right because it's not protecting you against your own antibodies so hashimoto may worsen when there's chronic inflammation and may improve when the inflammatory markers come down and go and act in other places where they're not need it like in your thyroid if you have antibodies against your thyroid so in that way yes they may improve the symptoms of hashimoto but hashimoto also if you have antibodies but your thyroid function is normal then you should not have symptoms from the antibodies necessarily.
- [38:10]
A
Per se what about people who already have stomach problems i have ibs and i'm scared it will make my symptoms worse maybe talking about the side effects.
- [38:18]
B
When used the right way by somebody who's gonna know how to guide you for the majority of patients ibs improves significantly again wow inflammation it's amazing it.
- [38:30]
A
All goes back to that and it really all goes back to making sure that you've got somebody that is knows how to treat you going into it and throughout the process because if you.
- [38:41]
B
Let'S say somebody with ibs and they get the medication by somebody who has no clue on how to guide the patient saf through this journey yes definitely it's gonna make your symptoms of ibs.
- [38:52]
A
Much worse is there anything that somebody can do once they're on glp one s to make them work better yes.
- [38:59]
B
One hundred percent the patient can be part of the success of this medication and it's going to be by what they eat and how they exercise to help glp one do its full time its full job which is decreasing your body fat decreasing your visceral fat you have to take care of maintaining your muscle mass because if you also lose muscle you don't lose as much fat as you would normally do so to so you're fighting yourself almost to maximize the effect of a glp one it's important that you increase the protein in your diet to minimize muscle loss or ideally because it's possible to even gain muscle while taking a glp one okay.
- [39:42]
A
I'Ve heard glp one s can help with pcos is that true and how.
- [39:46]
B
Yes so pcos is a problem of insulin resistant hyperinsulinemia hyperandrogenemia meaning making too much testosterone and glp one s regulate it improves insulin sensitivity so it decreases hyperinsulinemia and this will decrease the visceral fat and some of the symptoms of.
- [40:06]
A
Pcos wow so this question is from nicole i want to get pregnant in the next year should i wait to take a glp one no and i'm.
- [40:15]
B
Gonna tell you why wow okay we now know of something called transgenerational obesity meaning through generations we pass genes that can lead to obesity in our future generations right so one of the things i always ask my patients is i like to get to their family history three generations behind their parents their grandparents and uncles aunties and you can always find a pattern in the majority of patients of carrying obesity through generations and we know now by epigenetics changes of the genes through time because of environment because of hormones because of diet can be passed on so forty to sixty percent of somebody being at risk for obesity is going to be transmitted by your parents and your grandparents so if we have somebody thinking preconception to break this generational pattern of obesity the parents both mother and mother need to start in a healthy way preconception to minimize the risk of passing again the risk of obesity our parents didn't know that our grandparents didn't know that but now we know so we should act responsibly when we're thinking of conception can you.
- [41:45]
A
Take glp one s while you are.
- [41:46]
B
Pregnant or is that not unfortunately we don't study do studies on women but it's going to be more clinical experience so i personally have had some patients that got pregnant while taking a glp one not planned because also glp one can increase fertility for those that were struggling with infertility especially if they had pcos or obesity obesity because reducing visceral fat decreases hyperandrogenemia and increases your fertility so for many patients who didn't get pregnant or tried to get pregnant even patients that did ivf they go on a glp one they start losing weight and suddenly they do they come pregnant right in those situations we stop the medication and they've carried normal pregnancies and normal births so that's as far the information that we have now but i believe that in the future we will be able to use a glp one for gestational diabetes because people have to.
- [42:45]
A
Understand what those were originally originally intended.
- [42:48]
B
For exactly again it's going to have to be done by somebody with expertise because you don't want to suppress appetite too much in a pregnant patient and lead fetal growth retardation right so it's going to be very a very fine tune.
- [43:07]
A
Okay as we get closer to the new year i have been thinking a lot about the habits i want to carry with me into the next chapter of my life not just the next month and the one thing i've learned is that the best habits are the ones that are so simple you stick with them it's why ag one has become part of my morning routine it's the daily health drink that combines your multivitamin pre and probiotics superfoods and antioxidants into one one scoop i drink it first thing in the morning it's quick it tastes clean and it takes all the guesswork out of feeling like i'm doing something good for my body every single day and truthfully i started because i just wanted that one habit that i could rely on especially on the days when things get chaotic if you have been thinking about your own routines into the new year this is one habit you can start before january even arrives i mean you can have your ag one drink while you're listening to the tamsa show it's a tiny shift that makes you feel like you're taking control i use it and you should too ag one has their best offer ever if you head to drinkag one dot com tamsen you'll get the welcome kit a morning person hat a bottle of vitamin d three plus k two an ag one flavor sampler and you'll get to try their new sleep supplement agz for free which has been a game changer for my nightly routine routine that's drinkag one dot com tamsen for one hundred and twenty six dollars in free gifts for new subscribers this show is sponsored by midi health i have been there sitting in a doctor's office trying to explain what's going on with my body only to be told it's stress and that it's just part of getting older i was told that the brain fog the night sweats the sudden weight gain all brush off like it wasn't even worth looking into well midi is changing that again experience they're a virtual clinic built specifically for women in perimenopause and menopause and they actually listen to you their expert clinicians meet with you one on one they ask real questions and they create a personalized plan for your symptoms your hormones and your health they're also the only telehealth care provider in this space covered by major insurance if you felt dismissed or invisible in the health care system miti was built for you because this chapter of life deserves more than a shrug it deserves real support ready to feel your best and write your second act script visit joinmitty dot com tamsen today to book your personalized insurance covered virtual visit that's joinmitty dot com tamsen midi the care women deserve we have a lot of listeners that are in perimenopause and menopause and struggling with the weight gain we address belly fat a little bit do you think that it's something that we're going to start seeing as part of a routine routine option for women when they say i'm in perimenopause maybe i'm talking about hormones as an option will glp one s be right there behind hormones as something that's recommended not in place of but with it.
- [46:04]
B
If they have a body composition that shows that they will benefit from it.
- [46:08]
A
Yes okay is there anything we can do to combat the side effects i feel like everyone's complaining about nausea definitely.
- [46:16]
B
So that's why it's important to start at the lowest dose possible and do not move to the next next dose until you're symptom free otherwise symptom free being not nauseous not nausea no constipation or no diarrhea because at a higher dose you're gonna struggle even more so it's allowing your body to acclimate to the effects of a glp one right also following your cues internal cues when you start eating if you feel full even if you think oh my no this is a third of what normally i would need that's your body that's a medication working so that's where you stop otherwise if you overeat the fullness you're going to have nausea and potentially vomiting avoiding anything fried heavy and fat nuts can do this if they're eaten in excess so it's not just the bad fats it's also the good fats in excess can cause diarrhea i really.
- [47:11]
A
Want to try but i'm scared about bone loss i've been in the gym non stop will it reverse all i've done should i be worried no it's.
- [47:18]
B
Smart to make a connection between bone weightlifting and a glp one why because they are interconnected bone and muscle are a single unit they're two peas in a pod they're together whatever is going to make you lose muscle is going to make you lose bone mass whatever is going to help you build muscle is going to help you build bone mass what's the risk of glp one if not use property properly muscle loss so with that muscle loss with time it can also lead to bone loss and causing osteoporosis but when we talk about preventing muscle loss by increasing the protein in your diet we're also protecting your bones because the bone cortex is made from protein from collagen elastin right that go in the bone thickness so the same concept to protect your muscle it's the same concept to protect your bone as long as you're not losing muscle you're not losing bone mass yeah.
- [48:19]
A
That was a really good question and.
- [48:20]
B
That'S why you need a body composition just by going on a scale or your bmi is not telling me nothing of what's happening with muscle and i don't know what's happening with bone either.
- [48:29]
A
Yep how do i prevent ozempic face and then my question is what's ozempic.
- [48:34]
B
Face ozempic face is a term that became popular a few years ago i was even quoted in the new york times for it and it's basically the loss of of elasticity of firmness in the skin with saggy dry wrinkly skin right that can happen with any weight loss not exclusively from glp one medications any significant rapid weight loss can cause ozempic phase and it can cause sagging of the skin throughout the body not just in the face to prevent that from happening is slow weight loss all right if you're losing weight slow slowly it's already telling me you're not losing muscle if you're losing too much too fast and too much can be more than two pounds per week you're losing muscle because you're not eating enough protein in your diet and you need protein to make collagen and elastin for your skin for your hair hair is another one you are going to have hair loss if you're losing muscle you're losing hair if you're losing hair you're losing muscle because it comes from the same concept not enough macronutrients in your diet.
- [49:44]
A
What are the macronutrients that you suggest for people that are the top five.
- [49:49]
B
Or whatever it is number one protein to prevent muscle loss and to prevent bone loss hair loss and to really maximize fat loss fat fiber because many of these medications can constipate so eating some complex carbs high in fiber also hydration is also very important patients that complain of extreme fatigue while on the medication ninety nine point nine percent is related to dehydration so you have to proactively be drinking so this is the.
- [50:27]
A
Hair loss question but that i kind of already asked but i heard hair loss was a side effect of a glp one how do you prepare prevent.
- [50:32]
B
It increasing protein in your diet and not losing too much too fast ideally should be half a pound to a pound per week that's a healthy weight.
- [50:42]
A
Loss half a hundred pound per week so no more than four pounds a month exactly okay no matter what the weight is no matter what your weight.
- [50:50]
B
Starts out as for some patients with ex with with severe obesity at the beginning they may lose more but then it slows down or at the beginning also you lose water so it may be more at the beginning but eventually should be steady at half a pound to a pound per week what if.
- [51:06]
A
I don't want to take medication at all are there supplements or natural options that actually do something similar so there.
- [51:12]
B
Is a lot in the market of gummies that can increase your own glp one or certain diets to increase your own glp one our own glp one is fine we don't need to increase our own glp one our glp one is in normal amounts the problem with our own glp one is that it's broken down within two to four minutes by an enzyme called dpp four so it's produced it's secreted and then within four minutes it disappears in our system what we have commercially as glp one are long acting versions of our own glp one so if you are eating something taking a supplement to increase your own glp one yes you're gonna have more amount it gets destroyed or broken down the same amount of time within two or four minutes so it's not the amount it's the length that it lives in our body body what we have commercially are long acting versions of.
- [52:02]
A
It what are you hoping to see in the next year or so more understanding about glp one s more awareness less shaming of people definitely more acceptance.
- [52:14]
B
More patients feeling healthy more patients feeling healthy more physicians doing it the right way understanding how these medications work and how can you safely guide a patient through them because then the results are are life changing for our patients internally and externally also what i expect is that or what i hope in the next year or so is that we're going to do parallel physical weight loss with mental health therapy because we are concentrating as physicians we're chasing a result a goal but we're doing nothing for the mental changes that a patient is going to through weight loss and that's one of the parts that that's the third part of my book or part three in my book that i'm the most proud because nobody's speaking about that yet and i have this i'm lucky that i'm hearing seeing patients after long term being on a glp one achieving their weight loss goal what is happening is that we're not giving the patients the tools to confront once they reach a weight loss goal you have to understand that for many patients they've never been at a goal weight in their adult life so many patients don't know how to see themselves physically internally in that new weight that is a healthy weight for many of their spouses they didn't meet them in this weight they've never seen them in this weight right so there's a lot of internal changes that are happening the weight loss happens fast faster than the psyche catches up.
- [53:56]
A
With those changes they're not seeing themselves in a confident way now or they're just not sure who they are anymore they might not identify with that person.
- [54:03]
B
They see themselves still as somebody with obesity or overweight right they haven't accepted like their mind hasn't catch up with what they see in the mirror some patients are struggling with the concept that they're being treated differently that once they lose weight by society by friends than before so they're coming they're grasping the idea that they're still the same person that before they were not a bad person and now they're a better person that they're still the same person some are relationships problems with their spouses i've seen divorces and patients once they reach their weight loss goal why many reasons right maybe they were with a partner that they didn't think it was the best for them but they thought that's what they deserve at their prior weight whatever their self esteem was there because of the obesity or and now they may feel like they can do better right or the other way around they don't recognize the spouse now they're eating healthy now they're not drinking now they're going to the gym and that that brings their own projection into them if they don't have that life so many layers there's tremendous amount of layers i'm seeing a different type of anxiety patients are anxious of weight regain there for some patients they're petrified to regain this i never want to go back what am i going to do what if i run out of the medication what if they stop producing the medication right so i would say for the majority of patients it's happiness that when they reach a goal but we're not being fair with patients to give them the right tools once they're there we ask doctors okay you reach your goal you should be happy we save you from diseases but that's not the whole story.
- [55:48]
A
About it it has to keep going outside the doctor's office one hundred percent from your doctor's office to maybe another doctor or therapist yes doctor rocio i am so happy you came thank you for having me i'm so happy you came back and i'm so this this book is i really think a game changer for so many because it's the doctors that are gonna learn from it it's real people like myself that are going to understand and there's a lot of m like i i had no.
- [56:14]
B
Idea i talk about the history of glp one so people are informed and not scared where they came from where are they at is it from the venom of a lizard is that i really explained to patients to people when was the first discovery of a glp one it was done by a woman and many people don't know of course it was it was by a woman doctor svetlana mofso at rockefeller center she's the one that discovered glp one hormone in the human human body and we don't hear her name what year was that nineteen eighty two also it's good for people thinking of going a glp one but are scared of it people are already on a glp one but need better guidance or somebody who's reached a goal and how to prepare them when they're there regarding the physical weight and all the changes that we just mentioned that go psychologically sociology culturally right.
- [57:02]
A
I never thought about those i thought oh well so somebody will feel good.
- [57:05]
B
Nobody did not even us but now we're having masses of people reaching a weight loss goal and seeing the aftermath.
- [57:12]
A
Of what happens thank you so much thank you it's always good to see you you guys have such good questions right honestly this whole episode came from you i cannot wait to hear what you learned from the conversation maybe it changed your mind about glp one s or is helping you if you're on a glp one if you want to go deeper and i you know i really recommend this book in so many ways doctor rosio salas whelan's book weight comes out december thirtieth it is smart it's real it's gonna help a lot of people finally be seen and supported you can pre order it right now i'm gonna have all the links in the show notes you're gonna hear me talking about it on social media keep the questions coming though cause i love hearing what you want answered next today's podcast is sponsored by midi health so many of you know this but i was dismissed over and over again when i was struggling with perimenopause symptoms i didn't even know i was in perimenopause it is so important you're getting care from someone that specializes in women in midlife and that they're willing to have the hormone therapy conversation with you i get questions from you every single day about where to go for support and i'm always suggesting midi health it's covered by insurance and you don't even have to leave your house ready to feel your best and write your second act script visit joinmidi dot com tamsent today to book your personalized insurance covered virtual that's joinmitty dot com tamsin mitty the care women deserve this episode is brought to you by progressive insurance do you ever think about switching insurance companies to see if you could save some cash progressive makes it easy to see if you could save when you bundle your home and auto policies try it at progressive com progressive casualty insurance company and affiliates potential savings will vary not available in all states.