Peptides

Weight Management

Mastering Weight Loss: GLP-1’s Revolutionary Role

Peptide Summit 2024

https://drive.google.com/file/d/1P6CwIVDH_z1kmZ4CqnWxeohzRsFv-V7p/view?usp=drive_link

It's kind of like how diabetics have problems with nerve damage in their feet. It could happen in the stomach, too. In a lot of these cases of people getting gastroparesis, it's probably because these GLP-1 are being used improperly or because someone already has an underlying disease with that. In addition, the GLP-1 can have beneficial effects on cardiovascular health and weight management. This is because patients are losing weight, and they're reducing some of those parameters. What is GIP? GIP is a Glucose-dependent Insulinotropic Polypeptide. This is an endocrine hormone that's secreted by the intestine in response to food intake. This is secreted by the key cells in the intestine. Particularly fat, is more responsive to this food intake. It stimulates insulin secretion from the pancreatic beta cells. similar to the GLP-1. This promotes glucose uptake by the cells, lowering blood sugar levels. GIP secretion is also glucose-dependent. It enhances insulin release when blood glucose is high.

In addition to its role in insulin secretion, GIP also contributes to lipid metabolism and energy storage. This is tirzepatide, and the brand names are Mounjaro and Zepbound, and this is also administered with a subcutaneous injection. That tirzepatide is the GLP-1 plus GIP. It has those two mechanisms. I have found that people tend to get more fat loss from the Mounjaro tirzepatide and the new Zepbound. A little bit more side effects, I'm seeing dizziness, which is very interesting with this one. There are contraindications to these. This is if there's a personal or family history of medullary thyroid cancer or anything with MEN2 or Multiple Endocrine Neoplasia Syndrome. In rats tirzepatide cause thyroid C causes T cell tumors.

However, it isn't yet known if this drug poses any risk for the increase of C-cell tumors in humans. with the GLP-1 and the GLP-1 GIP drugs there, that is a contraindication with that family history of those two cancers. But we have not seen any concern about these causing cancer in humans. Or they did some primary studies on relative contraindications, meaning, " should be cautious. There's a history of pancreatitis and gastroparesis, as well as some negative side effects of pancreatitis, which include inflammation of the pancreas, gastroparesis, about which we spoke about suicidal ideations, Gerd or Gastric Esophageal Reflux Disorder, and return of weight, and also some other side effects noted in the packaging on these drugs: difficulty in breathing or swallowing, fast heartbeat, gastric stomach pain, heartburn, recurrent fever, skin itching, rash, redness, stomach fullness, swelling of the face, throat, or time. When we look at these medications, it's just like any other peptide for me. It's a good idea to cycle them. The other thing that we want to be sure that we do is make sure we're using them appropriately. Make sure we're using them with patients who have already balanced their gut, fixed their sleep, and had their stress under control. Then there are the two big things for me. I tell my patients that they have to be eating adequate protein and lifting weights. Why? We have seen with these and in the studies that patients are not just losing fat; they're losing muscle too, and this is where we don't want to lose muscle.

Because, remember, muscle is a longevity organ. It's so good for us. We lose muscle as we age. It's called sarcopenia. We're losing muscle as we age. We're on a drug that makes us lose more muscle. That is not good. that could increase the risk of falling.  You need to have that muscle strength. I have protocols for patients, a six-week protocol for them to go to, and a weight loss protocol to prep their bodies for going on one of these GLP-1. My patients don't gain the weight back. What we're seeing with these studies is that not only are patients gaining weight back, but they're also going back to their baseline hypertension problems or hyperlipidemia problems. What does that mean? They're not changing their eating habits. They're losing weight, but they're still eating fast food every day. Yes, the cravings aren't going to be as great. You're not going to crave that food, and you're not going to go out of your way. But if you're still having the same habits, you might go back to those after. Then you'll gain the weight back. We don't want people to be on this long-term diet for weight loss or longevity. But it does do a lot of cool things. So let's go through some studies. I said for weight regain and cardiometabolic effects after withdrawing semaglutide, there was a step-one trial extension. This study was conducted one year after the withdrawal of a once-a-week subcutaneous semaglutide, 2.4 mg, and they had lifestyle interventions. Patients regain two-thirds of their prior weight, with similar changes in cardiometabolic variables. The findings confirm that they think these patients need to be on this medication chronically to maintain improvements in weight and health.

Now they're saying that they had some cell intervention. But I wonder what it was. where they are eating proper protein (30g per meal). Were they lifting weights? So another study on the clinical effectiveness of semaglutide on weight loss, body composition, and muscle strength in Chinese adults. This study involved 53 of these patients. They received 24 weeks of lifestyle interventions plus semaglutide treatment. The conclusion was that, in a real-world setting, semaglutide can reduce the weight and fat of obese patients while effectively maintaining muscle mass and muscle strength. which I love in this study is that they put them on a proper lifestyle portion. They had them working out and working to retain that muscle. Because if we're not using it, we're going to lose it, especially if you're not providing adequate protein and calories. The surmount for a randomized clinical trial with these participants is 783. This was a once-weekly subcutaneous injection of tirzepatide. Yes. because I was at 10 or 15mg for 36 weeks. Now some were continuing to see the appetite, or some were switched to placebo at week 36. The conclusion was that achieving clinically meaningful weight reduction during the 36-week tirzepatide treatment period, it had led to a longer treatment period.

Adults with obesity or overweight who continued the treatment at the maximum dose for an additional 52 weeks demonstrated superior weight management and continued weight reduction compared with those who switched off all Sibo. In a lot of these studies, they're just trying to be like, Hey, you have to be on this chronically. But I think that if you're just using it for weight loss, you need to take breaks. You need to develop habits. You need to use this smartly so you don't have those side effects. In another study, the step for a randomized clinical trial was semaglutide. But it had similar results. I think these studies are interesting to look at because we want to say what we talked about during the summit and what you guys will listen to as you listen to the other lectures, doctors, and clinicians: that we need to get our four pillars good before we dive into peptides. We need to get our sleep, our diet, or exercise. our breathwork or meditation. We need to get all of that together. So let's talk about dosing. Dosing for semaglutide: When it's compounded, it's a little bit easier to titrate. It's nice for patients because a lot of them are different. Some are sensitive to the nausea.

We want them to go slower. Some are not. They ramp up pretty fast. commercially available Ozempic and Wegovy come in at 4.5 and one milligram and two milligrams, and Wegovy goes all the way up to 2.4mg compounded. It's usually five mg/mL. You could titrate up slowly each week with a maximum of two milligrams. I don't have people on more than two milligrams, Maumjuro and Zepbound. That's the upper tide. That is the GLP-1 ship. Those are similar doses. They start at 2.5 mg, and then five, 7.5, ten, 12.5, and 15 mg, compounded. We start at 2.5 mg, and they max out at about ten. Other peptides used in conjunction with GLP.

I love CJC 1295 if a leaner Tessa Moreland because those are growth hormones that secrete a gog. Remember, they're substances that stimulate the secretion of our growth hormone from the pituitary gland. They work by binding those specific receptors in the pituitary gland, triggering the release of growth hormone into the bloodstream. Not growth hormone or hormone does not give growth hormone, but supporting your body is secreting that growth hormone, which does decline as we age. why growth hormone? Why is this a good fit? Because muscle all the I can't say the measure but muscle right. growth hormone in muscle. That's why this is such a good pair with the GLP-1 and GLP-1 gaps. Because you are supporting that muscle growth. They're taking five days out of the seven. A growth hormone secreted by Gog, along with their semaglutide, which nurtures appetite. So they're working on all the facets to just be healthy and create a lean body and lean muscle mass. So that's my thought. You can do it right. Or you could do it wrong. There's a lot wrong going on right now. But it shouldn't be all or nothing. I get triggered when people say that semaglutide is horrible. It has done amazing things for patients who needed it to move the needle. Now, they're doing so much better. You just have to work with someone who knows how to use these peptides properly and in the right way. Thank you for listening to the mini-talk. See you soon.

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<h6>Jen Pfleghaar, DO, ABOIM</h6>
Hi, everyone. It's Dr. Jen for a mini-talk. Today we're going to talk about the GLP-1 and the GIP. What am I saying? The GLP-1 are peptides that you have heard about in the news, semaglutide. Semaglutide has the brand names Ozempic or Wegovy, and these are administered via subcutaneous injection, usually in the abdomen. What does GLP-1 stand for? Stands for Glucagon-Like Peptide One. This is an increase in hormones secreted by the intestine in response to food intake secreted by the L-cells in the intestines, specifically in response to food intake. Stimulates insulin secretion from our pancreatic beta cells in a glucose-dependent manner. This means it enhances insulin release when blood sugar levels are high and inhibits glucagon secretion from the pancreas in the alpha cells, and this helps reduce glucose levels and slow gastric emptying, which leads to increased satiety and reduced appetite. A lot of people with GLP-1, this is where they say that maybe they get constipated from slower motility in the GI tract. And then we also hear case studies of people getting gastroparesis or a slowing or paralysis of the gastric stomach. When we talk about gastroparesis, it's the paralyzing of the gastric muscle so it doesn't drain as well. People are stuck with these, like, food boluses. They're bloated. It's been painful for days. What happens is that this is a natural consequence of having diabetes Type 1 and Type 2. That could happen because it's affecting the nerve cells there.

https://d1tnc8rqovg0h0.cloudfront.net/2024+Summits/Peptide+Summit+2024/Transcripts/2024_Peptide_Mini+Talk+Day+3_Transcript+File.pdf

Dr. Jen Pfleghaar is a double board certified physician, Emergency Medicine and Integrative Medicine. She graduated from Lake Erie College of Osteopathic Medicine, trained at St Vincent’s Mercy Hospital for EM residency and her Integrative Medicine fellowship was completed at the University of Arizona Andrew Weil Center for Integrative Medicine. 
She is the co-author of the book Eat. Sleep. Move. Breathe. A beginners guide to a healthy lifestyle. Dr. Jen is a board member for the Invisible Disabilities Association, American and Vice President of the NWOOA (Northwest Ohio Osteopathic Association). 
Her own battle with Hashimoto’s thyroid disease led her to make it her mission to help others suffering from not only thyroid disease but other chronic illnesses, such as Lyme, Mold and other autoimmune diseases. 
She really enjoys teaching on her social media Instagram and Youtube where she is @integrativedrmom and her website healthybydrjen.com 
Practicing in Ohio and virtually she guides patients back to health! 
She likes to also spend her time at her children’s sports games, boating with her family, reading the Bible and lifting weights. 
Social media handles 
https://www.youtube.com/@integrativedrmom 
https://www.instagram.com/integrativedrmom/

Mastering Weight Loss: GLP-1’s Revolutionary Role

Jen Pfleghaar, DO, ABOIM

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Jen Pfleghaar, DO, ABOIM