Full Transcript Introduction to GLP-1s and the podcast 0:00 your doctor's telling you to be on GLP-1 for life, run, because that is not how medicine goes. 0:04 We usually start out with a microdosing combined with certain things like IGF-I therapy, testosterone therapy estrogen, progesterone. 0:09 When we're looking at the different types of nutrition, we are making sure vitamin D, B12, magnesium, calcium, all these things are correct. 0:15 Were also going to diagnose and make sure there's no thyroid issues. 0:17 There's a lot of contradictions with GLPs. 0:19 Making sure that you're setting yourself up to win when you start GLp1s is probably the most important part of what GL1 therapy is. 0:26 we know that we actually know this peptide works. 0:28 You know what's going happen. 0:29 And everybody jumps down, oh, I know what's going to happen. 0:31 They look at the finish line, but you don't look what that journey is to get to the finished line. 0:36 Sometimes that is the journey to getting to that finish. 0:38 You might get there, you might be in a very unhealthy way. 0:40 If you do it correctly, GLP-1 therapy is fantastic. 0:43 I think it's one of the most revolutionary things that's come out of medical world. 0:47 But with the good, there's always the bad, the yin and the yang. 0:50 And people aren't paying attention to yang! 0:53 You're listening to the Lifestyle Medicine Podcast with Dr. 0:56 Ivan Rusilko, brought to you by Access Lab, where we explore new perspectives at the forefront of personalized healthcare. 1:06 Welcome back to the Lifestyle Medicine Podcast. 1:08 I'm Dr. 1:09 Ivan Rosilko, your host. 1:10 And today I am coming at you from Patagonia, Argentina, where we're going to be talking about GLP-1s, the good, bad, and the ugly. 1:17 We are powered by Access Labs. 1:20 If your doctor is not checking your labs, they're not a doctor. 1:23 So today, with the amount of craze that goes into what GLPs are in the multi-billion dollar industry, I thought it would be a good idea to kind of break 1:30 down the parts of GLPS, along with there's a lot of bad aspects that not many people talk about.
How GLP-1s work in the body 1:35 Um, you know, cause people think, yeah, losing 30 pounds on the scale might seem really, really good, but what are you actually losing? 1:42 So we're going to get into the good the bad and the ugly of GLP one. 1:45 So what does GL P one stand for? 1:47 GL p one stands for a glucagon like peptide. 1:49 This is something that naturally occurs in the body and it works really on three areas of the. 1:53 First and foremost is your brain. 1:54 It kind of makes you feel like. 1:55 Okay, I'm full. 1:57 It's kind of like the anti-dinner bell. 1:59 You produce this after your body's eaten and it's just like, okay, we don't have to keep creating all this different type of energy. 2:05 So, you feel more full, then it works on your stomach where it decreases gastric emptying, which also helps you get the feeling of satiety or you'll feel 2:13 as hungry because your system is not moving as fast. 2:15 Where it really works, though, is the pancreas and the liver. 2:18 Helps the Pancreas with insulin and actually liver with decrease in the amount of sugar the actual liver produces throughout the day. 2:24 day. 2:25 GLP-1s work in a very, very fast way, but with what we've done as humans, as we always do, we kind of take into the next level to where these hormones 2:33 are available throughout the entire day, so now instead of, you know, just after dinner for a few hours, We don't feel full throughout day which is what 2:39 were going to get into and kind show why that is not a good thing. 2:42 Even though you might be losing weight, what are you actually losing? 2:45 Muscle, bone, cartilage, tendon, all kinds of different stuff. 2:48 like that. 2:49 So we're going to definitely dissect how that actually works for you. 2:52 But first and foremost, we have to talk about what metabolism is. 2:54 Metabolism is the most important part of what makes humans human. 2:57 We do have the basal metabolic rate. 3:03 When it comes to the thermic effect of food, a lot of people don't understand what that is. 3:07 The thermically effective food is basically the amount of energy that it takes to actually consume food and process it as well as incorporate it into the system. 3:14 It accounts for anywhere from 10 to 15-ish percent of your overall metabolism. 3:20 It's extremely important. 3:21 Again, so when people don't want to eat, they go on fast. 3:23 They do all that kind of stuff. 3:24 You're really crippling 15% of your actual metabolism to where metabolism is a good thing. 3:28 If you want it, it helps you burn fat just because.
Metabolism, muscle, and weight loss vs fat loss 3:31 And when you're not eating, you actually decrease that actual portion of it. 3:35 Then you have the most basic one that everybody knows is the thermic effect of exercise. 3:40 This accounts for, and again, from 20% mating around there. 3:43 Again, these are all generalities depending on who you are and how you work out. 3:46 But what this is, this the amount of energy that is burnt exercising. 3:50 And again you have two different types of this. 3:52 This is the active version and the kind of passive version. 3:55 The passive versions is getting, standing up, moving around, spinning your desk, typing, things like that. 3:59 Um, the amounts of calories that are burnt just to kind, you know, move throughout the day. 4:02 So that's your thermic effect of exercise when it comes to the passive variation. 4:06 The active version is we are doing various boot camp. 4:08 You're doing resistance training, you're running miles, or you are hiking, your climbing mountains. 4:11 This is the one that we actively engage in and this is what we kind of focus on in the actual exercise industry. 4:18 So like I said, that accounts for about 20% or it can be 30, it could be 15 depending on who you and how you do it. 4:24 But the part which is where GLP-1's kind of come in is your basal metabolic rate. 4:28 This is the big dog, this is most important part of metabolism and the biggest portion of this relies on the amount of muscle we have in your system. 4:35 So if I were to wake up, the last time we checked my mind was around, I think it was 3,000 because I knew obviously the bodybuilding and all this other 4:41 kind stuff. 4:42 For me to get up I literally lay in bed and if did nothing else just because of the amounts of muscles on my system and how I trained my body throughout 4:49 the years, I burn anywhere from 2,500 to 3,000 calories just living and this is all based off the amount of muscle that I have on my actual skeleton. 4:56 The problem with GLP-1s is it kind of works against that. 4:59 So when you start to say I lost 30 pounds, you're not losing 30 lbs of fat and that's what people don't understand. 5:04 Weight loss versus fat loss are two completely different things. 5:08 Weight loss, I hate. 5:09 When my patients come into my office in South Beach, it's just like, ah, gonna lose 20 pounds. 5:14 It's like no, no you don't. 5:16 Just because the scale says you're 150, getting to 110 is not what we're really looking at. 5:21 We want to look at fat loss and lean muscle gain. 5:24 And this is where GLP-1s can kind of come in. 5:26 They help with certain parts of fat lost, but you are also losing muscle, you losing bone, and this where it can get kind dangerous. 5:32 A lot of people don´t properly test before they go on GLPs, And this is where you can really inhibit how your body works as a whole. 5:39 And with my practice, I never jumped on the entire massive boom of prescribing semaglutide and trisepatitis tic tacs like many physicians throughout the 5:47 country did. 5:48 But you could find it at Costco now, because that can get very dangerous. 5:52 We're going to get into the actual reasoning behind that and how diagnostic testing is so important before you go on a GLP-1. 5:58 because maybe just manipulating how your hormones work, your nutritional balances, things like that, can help you lose that pesky weight that kind of just 6:05 sits there without having to kind alter how you're metabolism works artificially. 6:10 So we're going to jump into that as well for that. 6:13 And one of the most important parts when it comes to GLP-1s is the way it works. 6:17 It kind decreases your your drive to eat, which again, we should be eating frequently. 6:24 Eating frequent meals, even as I'm also a nutritionist, so you bring that aspect into the medical world. 6:29 I always sit there and say every three hours or so, a snack or something, it kind of helps manipulate certain hormones, as well as it gives your body a
Hormones, thyroid, and nutritional testing 6:37 plethora of readily available essential fatty acids, essential amino acids to kind build things, to help make things work. 6:42 That's one of the most important things. 6:44 We need to fuel our fire. 6:45 If you own a Ferrari, You need to make sure you're not driving on empty, and GLP-1 kind of pushes you towards that aspect of it. 6:53 When it comes to your hormones, so there's a couple hormones that it works on not the best of ways. 6:58 Again, you know, when I'm testing, I always test for T3, T4, TSH, in reverse T-3. 7:03 If you are suspecting all other things, TPO and things like that for Hashimoto's or anything else like always good to incorporate, 7:09 but when you come in and you start manipulating how your metabolism works, your overall metabolism function. 7:16 The most important part of metabolism is thyroid. 7:18 Then we have growth hormone. 7:20 I check for IGF-1 regularly. 7:21 It's probably the most overlooked hormone when it comes to testing on any patients that come with labs that aren't from my clinic. 7:27 IGF-1 is one of the most important things. 7:29 It's a huge anabolic hormone that is responsible for incorporating the environment into tissue, into bone, and pretty much everything. 7:37 And it is the metabolic signal. 7:39 So when you're not consuming regularly, IGf tends to dip off. 7:43 You might even throw yourself into something called somatopause. 7:45 Somatophause is a gradual decrease in IG-F1 over a lifetime. 7:52 With that, there's lot of risks that actually come into that. 7:55 Uh, and again, especially once you get into the perimenopausal, menopause years or the andropausals years and men, if you're not putting more, 8:01 more mass in your system, you know, your bone gets, uh, yeah. 8:04 Your bone production gets inhibited. 8:05 So osteoporosis is a gigantic issue. 8:07 You're seeing the GLP ones, osteoperosis and osteopenia because people aren't eating, they aren''t forming bone. 8:12 but you lost that 30 pounds, but it lost the wrong 30. So that's kind of one of the biggest ones there. 8:17 Also, when it comes to, you know, as you get older in years, it's much harder to build muscle, mostly because, and then of course, 8:23 I touched on testosterone, both free and total is what I test as well as bioavailable in some instances. 8:28 Um, so, testing for this, total testosterone is how much your body actually creates, free testosterone as how you're actually able to use. 8:34 Again, It's always good to test for both of these because testing through your total Testosterone is super important because it shows how your bodies producing it. 8:41 And then testing for your actual free testosterone is how much testosterone's available for you to actually use. 8:46 And this is where you always want to add in sex hormone binding, globulin, albumin and things like that because these are the other hormones in the body 8:52 that can actually inhibit how many testosterone are readily available. 8:55 So as we use DLP-1s, we decrease our metabolism, our body doesn't need to produce these andrenomes as much, therefore you start to lose testosterone. 9:01 In men and women, you see sexual dysfunction, mood dysfunction energy displacement. 9:05 All these different things start coming because now you're telling your body, hey, I don't need a big metabolism because I'm taking this shot or now they 9:12 have in pills. 9:13 So your body starts to actually decrease that. 9:15 And again, testosterone is sister, which is estrogen and also progesterone. 9:21 Estrogen is an anabolic, it's a building hormone. 9:24 You start to see these dynamics. 9:26 It builds bone as well. 9:27 When you start getting hip at these, then you have all the different issues like we spoke of before. 9:31 Decrease in muscle tissue, decrease in bone, especially in your perimenopausal years or antipausals years as So what we do is, 9:39 especially in my clinic, is your diagnostic testing has to be very robust before you go on to a GLP. 9:45 Well, number one is if you can fix something more naturalistically, it's much more, I guess, healthy or more appealing to us functional medicine type physicians 9:55 because you're telling your body, you are teaching your, body not telling, teaching, your how to do it on its own. 9:59 So if you're able to sit there and increase somebody's protein retention, that's something great because now the hormones are much higher. 10:06 You're much more youthful. 10:07 Or if needed, if extremely, you are diabetic, pre-diabetic, and if your obese, not just I need to lose five pounds, I'm gonna lose 50. GLP ones do have 10:17 a place, but you gotta make sure that you actually using them with everything else in line.
DEXA scans and starting GLP-1s safely 10:22 If you can't just drop this nuclear bomb in and not be ready for it. 10:25 um so that's why testing again my my panel usually include the cdc which is extremely important to say your blood vessels are your immune system is i'm 10:32 sorry not blood muscles your your actual red blood cells yourimmune system cmp is great because it shows your kidney health is electrolytes, 10:42 all of your protein balances. 10:43 With that one, then of course the hormones, your thyroid, TSH, t3,t4, reverse t-3 sometimes TPO depending. 10:50 Then you have your estrogen, progesterone or estradiol, which is what is called on the actual lab test. 10:57 You take a look at your free testosterone, your total testosterone and your SHBG. 11:00 You look your cortisol. 11:01 Look at you're DHEA. 11:03 Make sure your adrenal functions properly because again, adrenals are a major part of how you actually live, how your function and they coincide with metabolism 11:11 greatly for that. 11:12 Then obviously we're checking everything else in the system. 11:15 IGF-1 like I said before is one of my favorite ones that's extremely overlooked. 11:19 for that, but you need all these different hormones to make sure that when you drop a GLP-1 into that it's not going to throw you into more of a perimenopause, 11:26 menopausal, endocrine, metapause type situation. 11:29 because you're decreasing your actual, you know, the food intake which then decreases metabolism overall for that. 11:36 So again, that's one of the most important things. 11:37 Some people like to get DEXA scans, some people get pre-nervos or these MRIs that show everything else as well, which is a very smart thing to do. 11:44 DExA is great because it's going to show your fat mass versus your perpendicular skeletal lean mass, amount of bone mineral density. 11:50 Those are great to have aswell, especially when you are starting out on a GLP-1 journey. 11:54 And I always tell people, start small and work up from it. 11:57 Some people come in and want the maximum dose each time, so they see the biggest amount of weight loss, which is the wrong term to be losing. 12:04 But that's just one of those situations to where you need to find a physician who understands the actual metabolism, understands how hormones work together, 12:10 understand nutrition, because the GLP-1 is a big deal. 12:12 This is situation where if you are working on something, you're going to on it for a very, very long time. 12:17 in certain situations, so you need to understand how it's working in your body, not just when it comes to the weight loss, 12:22 but how its actually interacting with the various hormones in the body. 12:25 And when you start monkeying with that, you have your BMR percent drop, your endothelmic effect of food which drops, and then again you might be trying 12:30 to exercise with it as well, which then just instead of anabolism, it goes into catabolisms. 12:35 which is not what we actually want. 12:37 So it's a situation where GOP1s can be great. 12:40 They can help with pre-diabetes. 12:41 It can with diabetic issues. 12:42 That can't help people who have been trying their hardest in a mental way to actually see that actual scale tip in certain way. 12:49 When it goes from helpful to hurtful is where the physician needs to step in and be like, this is the line. 12:54 You're going past it. 12:55 We need to make sure that your hormones are robust. 12:57 Make sure your nutrition is proper. 12:58 And make that there's no toxins in your system. 13:00 I mean, make you're doing this in non-abusive type way A lot of people sit there, they'll start taking a shot or taking the pill and they will sit and think, 13:08 I can eat pizza, this, that, and then now you're losing muscle and all of a sudden, you are actually gaining fat, but you lose everything else.
Risks of poor use and rebound weight gain 13:16 It looks like you losing weight and again, skinny fat is not fun. 13:20 I'd rather be a little more pleasantly plump and healthy than look like a... 13:24 a cartoon character. 13:26 But it's a situation as you have to understand that, you to identify that. 13:29 And then of course, once you get to your certain goal weight, everything's functioning right. 13:32 If you've done it correctly, it is the coming off of the natural GLP-1s, which is one of hardest things because you see a gigantic increase in weight for 13:39 people who don't do it properly because the entire time they've been relying on this shot to help them lose this extra poundage, 13:46 And their hormones are completely shot. 13:47 Their ability to sit there and understand how food works, what to eat, where to, how to it. 13:51 All these different things go into it and all of a sudden you stop the shot and you basically just gain all the way back and in some instances you gain more. 13:57 So now you've actually done more harm to your body even though you think you lost weight. 14:00 You lost what you shouldn't have lost and also now your going to gain back even more of the bad stuff. 14:06 which is what you don't want. 14:07 So I tell everybody, GLP-1s can be great, but you really have to, again, I think the diagnostic testing part of what GLp-2 therapy is, 14:15 is the most, it's your starting point. 14:17 It's where you have start and if you start there and you've gone in and your doctor said, oh, you'll lose weight here, boom, 14:22 and just gives you this thing, they haven't checked your HbA1c, insulin, all these different factors before you go on to it. 14:28 you're at the wrong doctor. 14:29 GOP1s are extraordinarily profitable. 14:32 They really are. 14:33 I mean, they will get you results, like I said, good or bad. 14:37 And the doctors just start on there, and they're like, I'll figure out, you know, the come off down the road. 14:43 Or they just expect a patient to be on it for life. 14:45 So if your doctor's telling you to on GOp1 for Life, run, because that is not how medicine goes. 14:50 You know? 14:50 I personally, we usually start out with a microdosing combined with certain things like IGF-1 therapy, testosterone therapy, 14:57 estrogen progesterone, whatever it could be. 14:58 You know, we're looking at the different types of nutrition. 15:00 We're making sure vitamin D, B12, magnesium, calcium, all these things are correct. 15:12 But, you know, making sure that you're setting yourself up to win when you start GLP-1s is probably the most important part of what GL-P1 therapy is. 15:19 We know that we actually know this peptide works. 15:22 we know what's going to happen. 15:23 And everybody jumps down, oh, I know it's gonna happen, they look at the finish line, but you don't look what that journey is to get to the finished line. 15:31 Sometimes that the journey to finish the line you might get the the finishing line but might be in a very unhealthy way. 15:35 If you do it correctly, GLp-2 therapy it fantastic. 15:38 I think it is one of the revolutionary things that's come out of actual medical world.
Final advice on proper GLP-1 therapy 15:42 But with the good, there's always the bad, the yin and the yang. 15:47 And people aren't paying attention to that yang, and I think that's probably the most important thing when it comes to GOP-1 therapy. 15:53 So guys, it's been absolutely fantastic coming at you from such a far remote place. 15:58 We're down here swimming with right whales and elephant seals and all kinds of fun stuff. 16:02 but we've gotten so many questions on the GLP-1 thing. 16:04 We've covered likely uncertain things on The Lifestyle Medicine Podcast, so I thought I'd take a minute and kind of go after the proper ways to diagnose 16:11 how to put people on GL-P1 therapy and how do it right. 16:16 So again, my name is Dr. 16:17 Adam Rasilko. 16:17 This is The lifestyle medicine podcast for Power by Access Labs. 16:20 If your doctor's not checking your labs, they're not a doctor. 16:23 You can find us on YouTube, on Spotify, Apple. 16:26 Anywhere you find podcasts will be there. 16:29 Just let us know some more topics you want me to cover solo. 16:32 We've got a lot of cool guests coming up too. 16:34 It's been great to take a minute out of my day and get at you guys. 16:37 Thank you for joining and stay tuned. 16:39 Thanks for joining us today on the Lifestyle Medicine Podcast. 17:09 thousand routine and advanced biomarkers with 24-hour results. 17:15 When signing up, select Lifestyle Medicine Podcast as how you heard about us and score 10% off your first invoice. 17:23 Oh, and don't forget, drop us a review. 17:26 It helps more practitioners like you find us. 17:30 We'll see you next time.
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