GLP-1 Microdosing, Menopause & the Wild West of Midlife Weight Loss

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What does the growing GLP-1 microdosing trend mean for people navigating weight changes in midlife?

Board-certified OB/GYN and certified menopause provider Dr. Kim Einhorn joins Kim and Kat to explain what microdosing is, why people are trying it, and what we know about its effectiveness and long-term use for patients with and without obesity.

She also discusses the concerns women bring into her practice, compounded medications, telehealth care, and protecting muscle and bone health during GLP-1 treatment.

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SPEAKER_02 1:33

Are you interested in understanding GOP1 medications like Osimpic, Wolfopi, or Minjaro? Then join us on the Plus Side, Cracking the Obesity Code, the groundbreaking podcast helping people change their lives one episode at a time.

SPEAKER_01 1:47

The Plus Sides podcast is a Destructor.

SPEAKER_02 1:49

We're breaking down barriers, smashing stereotypes, and sharing inspiring stories that'll leave you feeling informed and empowered. Join us every week to learn from doctors who are specialists around GLP1 medications, like OcinFit, Bogovia Manjaro. They'll provide you with science and facts to validate these incredible stories. But that's not all. We'll also bring you the voices of the GLP1 Manjaro TikTok community, real people who face the challenges of obesity-related diseases and disorders and discover the incredible plus sides of GLP1 medications. Our episodes are filled with heartwarming stories, laughter, and moments of triumph. You'll connect with our amazing community members who are reclaiming their health and experiencing their fullest lives. Are you ready to embark on a journey of discovery and empowerment? Tune in to the plus sides cracking the obesity code, and together we'll change the narrative around obesity and in the stigma. Subscribe now on YouTube or your favorite podcast platform and join our incredible community. Let's celebrate the plus sides of life together because every story deserves to be heard. Every life deserves to shine, and everyone deserves access to expert knowledge and medication. The Plus Sides Podcast. You're not alone. It's not your fault. Most GLP1 providers write your script and then wave you off and say, just died and exercise. And if you're lucky, you'll actually get someone that'll help you understand how to manage your side effects. If you listen to this podcast regularly, you know that as an obesity care advocate, I believe that this journey is really complex and that you deserve better than just a weight loss program. Bell is different because they care both about community and the patient experience. They sponsor this podcast and they even brought me on as a strategic partner. I'm a Bell patient too. And if you use Bell as your provider, I can actually be part of your journey because I run a weekly patient support group hosted in their community. This is the kind of care that I want for you. And I'd love to see you there. Go to link.joinBell.com slash podcast and use code podcast at checkout to save. I hope to see you there. Give me one minute of your time. After three years of interviewing obesity medicine experts and hearing from tens of thousands of you, I still see the same gap in support between getting your prescription and then actually getting whatever you need to achieve whatever your goal is. Amanda and I are both tired of it. So we decided to fix it ourselves. Inside Cozy Butter, we have live support groups, health coaches, expert QAs, cooking and movement classes, recipes, side effect resources, calculators for your protein, your water, your fiber, even a protein meal builder, medication comparisons. So you can look at the ones now and ones in the future, all with trusted cited sources. And beyond all of that, we're creating a space for you to build real authentic connection. GLP ones are amazing treatments, but they're not cures. So we're going to need to support each other for years to come. You can join us for free today at cozybutter.com. You deserve better. You deserve butter. Welcome back to the butter way. Hey, plus science community. Before we jump into the podcast, do me a favor, like, subscribe, and share if you haven't already. This helps us get referred up in the algorithm so we can find more people that need our help and guidance from our doctors. Thanks so much for supporting the show. Let's jump in. Welcome, welcome to the Plus Sides podcast. How are you doing, Amanda? I'm good. I'm happy to be here. Yeah, I'm glad to have you. Thanks for co-hosting with me. Do you guys know our cat is taking a little break right now with some family stuff and much needed, well-deserved break uh from the podcast? And I've had doing some things myself. Bears popping in, Amanda's popping in, uh, you know, just so we can have some, you know, good banter, you know. And Amanda's definitely funnier than me. And we have to have some funny, don't we?

SPEAKER_04 5:48

Yeah. Stop lying.

SPEAKER_02 5:49

Where are you lying? So we're glad to have you. We are now going to do intros. Um, if you are a regular and you don't want to listen to this, this is your cue to fast forward. But I gotta tell people. We have hundreds of people that follow us, like every every that find us every week. So, you know, we gotta tell them, right? Okay. Uh, if you're new here, my name is Kim, uh Kim Carlos, and I am the producer of this podcast and host. Kat uh is my usually co-producer um and uh co-host. Uh, and uh she's just like I said, out. But this podcast is an education and advocacy podcast for people who struggle with the disease of obesity or metabolic disease in general, insulin resistance. Like it's pretty broad at this point, but it's people that struggle with weight because of medical stuff. Okay. So we're glad to have you here. This podcast is very reputable. I know that you're looking for good quality sources. I have the best doctors on here that know the most about this particular area, scientists, researchers, dietitians, all the things. Okay. And it is so that you have a place that you know is a sound source for information. We have won four awards. Um, and we are in the top 1% of all podcasts in the world. All right, that was me trying to be quick for you because I know your attention span is short. So thanks for coming. I've been on GLP1s for over four years. I've been on all the subcutaneous shots. Um, I'll probably be on more, uh, to be honest, because I have obesity and I have blood sugar issues and PCOS and a lot of other things, and this treats all those things. So I lost 110 pounds um my first couple years on the meds, and I kept it off for quite a while. And then over the past year or so, I've had some regain. Not all of it. By now, I would have regained all of it and then some, right? But not all of it. I regained about 30 pounds. And um, I've had a couple surgeries. I'm going through midlife, uh, which we'll talk about today. And um I am somehow I've turned into kind of kind of SpongeBob square pants in my middle. It's very like boxy, you know? And I have all the hormones and things going on because I'll be 47 this year. So I've had some regain. My sister passed away, so I've had a lot of stress. I'm very open about that on here and with my content because you guys have it too. I'm not looking for you to feel sorry for me or anything like that. It's just I'm I just try to be my most most like authentic self and talk about all those things because all of those things affect your health and weight management. And I think it's important for you to kind of know and see what it is I'm doing and what it is that works and what it is that doesn't. So that's what we talk about here, okay? Um, Kat's been on them uh for as long as I have. She's lost a hundred pounds. She is our uh fitness uh extraordinaire. She she just loves to exercise and loves it. Loves it. And um, she also does on our um community, Cozy Butter, Fitness with Cat on Fridays. So if you guys are looking to join a community where you can get um nutrition and connection and social hours and all those different things, we have cozybutter.com that you can join. You've probably seen the commercial for it because I've likely put it in here. Um, but good news today, I actually have my co-founder with me for Cozy Butter, Amanda. Amanda, tell us a little bit about who you are and maybe some cozy butter stuff. Tell us about things you do and all that.

SPEAKER_03 8:53

Hello, I'm Amanda. Um, I'm the founder of the GLP One Studio and the GLP One Collective. And now I'm the co-founder of Cozy Butter. And I could not be more thrilled to be here and be able to share with the Plus Sides podcast. Thank you so much for letting me be here and um in place of Kat. I'm sorry that she can't be here.

SPEAKER_02 9:14

Yeah, yeah. No, I'm I'm thankful to have you, girl, of course.

SPEAKER_03 9:18

Well, you and I met two years ago when I first started my journey, and you were like a beacon of hope. And I just am so grateful to be friends with you and just be able to be a part of whatever you're you're building.

SPEAKER_02 9:32

Oh, Amanda, I feel the same way about you. Oh, this is gross. We have like Amanda and I have like just we we're good friends, but we just have this creative whoosh between us, and it's just really fun to help people and bounty if you've ever had a relationship with anybody like that where your just creativity just like feeds off each other, and it's just fun. Bread and butter. That's right. Yes, we should talk about cozy butter real quick, and then we'll get started. Absolutely have a community for our intro.

SPEAKER_03 10:01

Sure. For anybody that doesn't know, um, Cozy Butter is a GLP1 community for patients and allies. It's free and open to the public. We have um resources and tools to help you manage figuring out how much protein you need, how much water and fiber, and also comparison guide for GLP1 medications. So you can go in there and click around to compare all of the different medications that have been in the past, current, and even in the future from the science that we currently have. But what's more important is that we have a forum for people to connect and events for people to take that step another step further. So I am doing health coaching. I am an ascertified health coach with a weight management specialization and advanced training in anti-obesity medications. I lead our thriving Thursdays and we do group health coaching. It's been fabulous. We're all getting really attached to each other. And then Kim does support group on Monday.

SPEAKER_02 11:01

And I am also studying for my behavior change uh management uh certification. So hoping that I can help everybody as we we navigate this new world when our brain is free from noise and there's a lot of work that needs to be done. And in my opinion, most of it is here. So so we're trying to focus on those things, you know.

SPEAKER_03 11:23

Oh, yeah. Yeah. But we've got stuff every week, multiple times a week. We've got community members hosting things like hairstyling classes, yeah, self-advocacy classes, flower arrangements. We're looking at starting a walking group. And so our goal is to make sure that you are as cozy and supported as possible.

SPEAKER_02 11:44

Yeah, absolutely. I mean, like, I even did some journaling classes. Um, and it was it was really amazing, kind of some realizations that I had. So, like, for example, I'm just gonna give you an example of how these things can help. The the what stress does to your body with weight management and even midlife, and we'll talk about that today. It is amazing, not only what happens with your weight, but also happens with your energy expenditure and your mental health and all of these different things that happen, right? And the medicines are not cures, they're just really good treatments, you know? And so we're gonna be this is something we're gonna be dealing with for the rest of our lives until it you come up with a cure, right? And until then, we for especially even after, hopefully, we need to support each other. Okay. So Amanda and I really wanted to create this because we feel like a lot of a lot of like in between your scripts, what are you doing? You know what I mean? You're scrolling the algorithm and trying to figure out you never know who you're going to land on. You know what I mean? So we thought we have the podcast. Let's see if we can do this thing to catch you before you fall. Okay. So um we're so we're so glad to have you here today. Um, just know you can go check that out. We had Dr. Ogle come and do all the things and all the things that we have, like all the tools, they're all backed by science and the sources are cited. So you can be like, oh, like that's a valid thing. It's all going to like publish science. Okay. So be sure to check that out. Now, today we're gonna talk about microdosing and midlife and obesity and how all these things kind of smoosh together. Um, what is real, what is not, what is proved, what have we seen in real life? Like, and I'm very excited to um add in our special guest to have this discussion. Um, and I'll do it right now. Hey, have you remembered to comment, like, subscribe, share, click the reminder bell wherever you're watching or listening to this podcast? If not, please do it now so that you can help us grow and help more people. We love you. Hope you're enjoying the show. Well, welcome, Dr. Kim Einhorn. How are you?

SPEAKER_00 13:40

I'm doing very well. Thank you for having me.

SPEAKER_02 13:42

I'm on yeah, we're so glad to have you. Um, we usually start the show by asking our guests to tell us who they are and how they help people.

SPEAKER_00 13:52

Okay. I am um Kim Einhorn. I'm a board certified OBGYN. I've been practicing for about 25 years right now. And um used to do full scope, like delivering babies, doing all the gynecology stuff. But I would say over the last seven or eight years, developed a real um love for midlife women's health, perimenopause and menopause, and very quickly realized that one of the main issues in perimenopause and midlife for women is weight and dealing with how their PCOS affects them and all these things become compounded the minute our estrogen levels drop. So then developed, you know, in my my interest done kind of like parlayed into obesity medicine. I was a patient myself. I've been taking GLPs since 2021 when Zetbound first came out on the market. And, you know, that sparked my interest even more. So um, so basically now I have my own practice that is just focused on midlife women's health and menopause, perimenopause, and weight loss. So that's kind of what I'm doing now.

SPEAKER_03 15:01

That's awesome. Dr. Einorm, when women come to you after starting a GLP one elsewhere, what are the things that they're most concerned about?

SPEAKER_00 15:11

So most of the time, it it really depends where they've started it. Now, if they've started it with a um weight loss specialist, meaning someone that has, you know, their board certification in obesity medicine, and we do have a couple of really good responsible providers in my area, they usually don't have that many concerns because they've been counseled in nutrition and they've been counseled in their exercise and they've been able to onboard it successfully. But I have so many more women that have never had access to those physicians and they've either been getting it from their local plastic surgeon or their local aesthetician or like their dentist or something online and they I've got yeah. Oh my god, maybe I have the chiropractor one. You know, it's wow. This is the thing women in midlife are vulnerable because it's a time when things start going wrong, not just weight, but their mood, their anxiety, their, you know, their sleep. So they're preyed upon and they're just willing to do anything to feel better. And I think unfortunately, there are some, you know, less scrupulous providers that are willing to take advantage of that. So whether they know how to really safely get patients on GLPs or not, they're they're prescribing them and they're charging a lot of money for them. So I have patients that have come in and they they're like, I tried it, but I had intractable vomiting. I ended up in the hospital. I mean, that's unheard of in my practice. I've never had a patient even have a vomiting reaction because you you know how to do it the right way. So I've had that, I've had patients like say they have, you know, they they they come in and I have a body composition machine, so they've lost a lot of muscle. They start noticing they haven't been able to do the things that they usually haven't able to do, like lifting suitcases and you know, things like that, but they lost 60 pounds, you know, and so they're losing too much muscle. So they're just not getting the proper education and the proper monitoring to do it in the healthiest, safest way.

SPEAKER_02 17:08

Yeah. And they know it. So that's the concern.

SPEAKER_00 17:11

Yeah.

SPEAKER_02 17:12

I mean, I can honestly say that even with people that have had obesity, it's the same thing. And one of the one of the biggest reasons that that is, and I'm sure that you understand, I think that is that people who have had obesity for a long time sometimes have a hard time listening to their doctors who are now telling them the complete opposite about weight loss, weight gain, weight management that we've ever heard before. Right. Ever heard before. And it is really difficult to trust them because we have indeed been preyed upon by so many people. And it is because we are sick and we need medicine, is because we are desperate. And that just extends when you're someone with obesity going into midlife. You know what I mean? Someone with already struggling with your weight and going into midnife, and then it gets even worse, you know? So we have seen that for sure. And it is just really nice to have doctors like you that are like, I can help you manage your side effects, I can tell you the things that you need to be doing, right? And then our community, for example, is trying to catch that in between, right? Um, to support them on all those ways. Like we want them to have closeness and community and connection, right? Um, and we want them to be able to manage their stress. That's like such a big piece of it, right? And be social with people that they feel like understand them. So um I'm really glad they're doing that. That's amazing.

SPEAKER_00 18:26

Yeah, the the one of the saddest things, and it doesn't even happen infrequently here, is that our women that come in that are suffering from either being overweight or obese, and they've never been told that it's not their fault. They think that it is just they have they are lazy, they have lack of willpower power. I had one patient that actually was put on GLPs and was using them, but told me she cried every week when she had to give herself a shot. She felt so guilty because she was cheating and she didn't have the willpower. And these women need to know that I know these women need to know that, you know, they need to understand that this is this is a disease just like having hypothyroidism or having diabetes where you need hiplin and you need this thyroid hormone. And, you know, once I sit, and I'm fortunate in this practice that um, you know, I have 90 minutes to sit in with someone in a consult, and we really, I really can take the time to explain why their body needs this. And I I share my own experiences with them about how what what I went through in the first 24 hours after taking my first shot and how my brain totally changed that I never realized that not everyone on this planet thinks about food every minute or two minutes of the day. I just thought everyone had better willpower than me and they were controlling it. And then after I took my shot, I remember like I looked over at my husband who's always been thin, and I'm like, Do you think about food every like couple minutes? And he looked at me like I was crazy. And then I realized you're not like I'm not cheating, I'm like leveling the playing field. Yes, totally true.

SPEAKER_02 19:56

Yeah, I know it's such a big difference. We talk about that a lot here, but you know, I do a lot of like lives on TikTok and on YouTube, and the amount of people that come in that have that story is vast, still, still. So it's interesting, like we get kind of, you know, Amanda and I work, we're creators and stuff, we get kind of caught up in the algorithm and we think we're doing okay with, but the way the algorithm works is they only show people kind of what they engage with, right? And so we're kind of in a little bit of a bubble. So when new people right are coming in, then it's like we're really that's when you realize that the impact we've had while it is large, it isn't anywhere near as big as what the problem is.

SPEAKER_00 20:34

I say the same thing. I mean I'm in like a menopause bubble here and in my social media, and I still am shocked when every single day I have patients come in to see me. And I'm like the fifth person that they've seen to try to get hormone therapy, and they have no reason to not be on it. And they've just been told, no, you know, you your your mother had your grandmother had breast cancer, you can't be on it, or you just have to get through it, and they've been suffering and realize how many people really aren't educated out there.

SPEAKER_02 21:00

Okay. Um, next question. Um, I wanted to ask you about um when it comes to prescribing. So, what should a patient expect before a provider will actually prescribe the medication, right? Like what do they ask for? What do you need as a provider to be able to decide if it's right for them?

SPEAKER_00 21:20

So there's a few things that I will say that in my practice of menopause and of and of obesity, I do generally try to always stick to evidence-based medicine and screening and treatment guidelines. But since we're talking about microdosing, I will admit to the world that I do prescribe GLPs outside of the traditional treatment guidelines, meaning I don't have, I don't, I have a lot of patients whose BMI isn't 30. I have a lot of patients who are, but then I do have patients, women in midlife who've gained that 15 pounds and they have tried everything to get it off. Meaning they have they're counting their macros, they're exercising five to six days a week, like they know what they're eating and they cannot lose it. So I do, you know, it's not always the BMI of 27 with comorbidities. I will help women that also need to shed the the weight to make themselves feel better about themselves again. And which leads, which gets into answering your question, which is I do a lot of counseling for them before they start, meaning they have to understand what GLPs do, how they work, they have to understand how they're supposed to eat once they start taking GLPs because it is going to significantly cut down on the amount of food that you can ingest. So they have to understand that the protein and the fiber have to be there in every bite. You can't eat meaningless meals and fill up on meaningless meals and not get your protein and not get your fiber and not get your macronutrients, micronutrients. Um, and then we always do body comp before. So we're monitoring, we're monitoring their fat, we're we're monitoring their skeletal muscle. Um, and I'm usually doing bone density scans before just to see if there's any additional problem there that we have to worry about with once they start losing weight. So the people that cannot be on it are people that are, you know, like that they couldn't lose weight and still be healthy. That's kind of how I figure. And there's a big leeway. And when I get them on my body comp machine, I do see like even if they have um, you know, sometimes they have increased visceral fat, but their BMI is normal. That I put those people on it. But sometimes there is wiggle room. You can lose some fat and still be within a healthy range and not be putting yourself at risk. And And I do think that so much of feeling better is, you know, has to do with getting to be, you know, the weight that you once were maybe five years ago. It's just not, you know, and I have taken people off GLPs before. Like if it if it uncovers an eating disorder or things like that, I unfortunately have had to take them off. But there's so many other benefits that I start noticing because I prescribe and I do a lot of microdosing, not necessarily for obesity. And the things that have been uncovered have been pretty pretty surprising to me in the office, to be honest with you. So there's a lot of reasons why I why I prescribe it. But I do, you know, a lot of counseling before that first injection to determine, you know, whether they would be right for it and to get them on and safely.

SPEAKER_03 24:18

Yeah, that's interesting. So, what should patients understand about GLP1 microdosing specifically?

SPEAKER_02 24:27

So what is it?

SPEAKER_00 24:29

Yeah, micro dose compared to regular. It's not a medical term, um, but it's become a widely accepted and used term. And we know what it means now. It's using uh it's using a GLP in any dose that's lower than the lowest dose, or spacing your GLP dosing out to be less frequent dosing, like normally, you know, for instance, uh terzepatide or semaglutide are dosed weekly, but if you start spreading it out to bi-weekly, something like that. So that's the definition of microdose. And I will say that um I noticed there's a huge variation in the way people react to GLPs. There are patients that won't have a, they won't feel a single side effect or a single benefit, like for instance, of appetite suppression, until I bump them up three doses. And we're not talking microdoses. We're starting regular dosing, bump them up every month until they're on, you know, something like 10 milligrams of trzepatide. And only then do they start feeling it. I have patients that are GLP um resistant and I have them on 15 milligrams and they haven't even lost, maybe they've lost three pounds and they and they are in the obese range. So, and then I have patients that I will start out on on a microdose because I've seen people react violently to like a 2.5, for instance, milligram dose of trzepatide and have, you know, nausea and sometimes vomiting and things like that. So the microdose is something that I do like to start almost everyone out on because I like to test the waters and see what kind of reactor you are. I have a patient that lost 100 pounds on a half of a dose of the lowest dose of trusepatide. They're so sensitive to it. And we don't get have the technology and the research to tell us who's gonna be a responder and who's gonna be a non-responder, although they are developing that now. I know 23B is like looking at that. So we don't really have that testing beforehand. So I do tell my patients, I'm gonna give you, I can start you out on a microdose. I kind of give them the choice. If they have, if they have insulin resistance, which is another thing that I look at, you know, if they have PCOS, if they have diabetes, I know that they're not, they're probably gonna need more than the the small doses, but I do give them the choice because the worst thing is to try to onboard a GLP and have someone feel terrible once it's injected for like the next three to four days. And I see the worst case is that for one week you're not gonna really have the weight loss that you'd wanted. And we've just kind of like wasted a week, but that's the worst case scenario in a microdose start situation versus the the nausea vomiting on a 2.5 milligram dose. It's not common, but there's no harm in starting slow and just going and starting low and going slowly. So, you know, we usually will start at that little microdose, and then some patients can see a difference on that microdose the whole time.

unknown 27:12

Yeah.

SPEAKER_00 27:12

Now with microdosing, we know that you can have weight loss on microdosing. We know that, and I and I know anecdotally, and I think, and these studies are being done now that you can have the other benefits like anti-inflammatory benefits. I've had patients miraculously like lose. I mean, I've I had one patient that, and this is all anecdotal, just so you're listening, yeah. It's not randomized controlled trials, but you know, patients that have come in that have been very hesitant to start GLPs, but really do have the weight loss issue, but have, for instance, IBS with constipation. And constipation is a side effect of GLPs. But she did, we did try it. I gave her the smallest dose because we were very kind of nervous about it. And one week later she came in and she said, I haven't been pain-free in over 30 years. She used to travel with the whole suitcase full of laxatives. Yeah, she's got pain with every bowel movement and during meals, and she and she has remained to this day a year later um on a microdose, completely free of her IBS symptoms. And and since then, you know, they are doing research on Crohn's and all sorts of colitis and IBS with with microdosing because of the anti-inflammatory component of it.

SPEAKER_04 28:18

Yeah.

SPEAKER_00 28:19

So I've seen it like, you know, I have people that come in asking for it for that, or asking for it for their um, you know, um psoriatic arthritis and or they're even they're drinking like all sorts of little things. We don't have any evidence. There's no good randomized control trials out there right now about the microdose. We can't say the microdose is going to help with your um secondary um prevention of cardiovascular disease. We can't say it's gonna help with, you know, um with mash or, you know, your liver disease or your obstructive sleep apnea or anything like that. But we do know it helps with weight loss. And now we're starting to see a lot of the other um effects come in because it's just starting to be so widely used.

SPEAKER_02 28:57

Yeah. Yeah. I I no I totally agree. And then the reason we're having this discussion is because um, so as things I feel a responsibility that as these things pop up in the community, um, at some point I'm gonna have a discussion about peptides. I just I'm very picky about who that's gonna be. Oh I know, but and longevity and all that's at least know what it is. I know we have to know what it is, though, right? Like so I'm trying to find somebody that I feel like has the most background in it that's not just like like trying to pitch long, like you know what I mean? Because I don't think Western medicine has it all figured out. I like the idea of people being able to try different things, but I'm all about disclosure. And if the disclosure is, hey, these are peptides, they could really help you. But to be clear, we do not know what they are doing to your organs outside of like what you may be feeling, and there isn't a lot of data about it. But I do believe in body autonomy, right? As long as you know those things and their declose disclosure is there, then I don't care. Like, I mean, I'll be honest, like, I don't because because if Western hadn't medicine had it all figured out, none of us would be sick. Exactly.

SPEAKER_00 30:05

I do believe, yeah. I with peptides, it's a it's a very complicated, nuanced discussion.

SPEAKER_02 30:12

It is and I don't let me know if you think of anybody in particular that'd be perfect for that because I did look at it.

SPEAKER_00 30:17

I'll tell you, like, I don't know if this is on or off air. And you know, I know there's issues with like Peter Tian, Jeffrey Epstein, and things like that. But I did because my patients, my patients are all very um, you know, well-read, educated, they kind of are already being offered all the fancy things by like all the longevity doctors in my area. They come to me with all these questions. So I do a fair amount of research on them. And, you know, even though I um I have like my love and hate with Peter Atiya, I did go to his podcast recently and listen to what he said about peptides because he's a longevity doctor and he also is very, he's actually very um good at on um dissecting the research. And you know, his discussion on BP 157 was very helpful for me to discuss with my patients. And so I think he is like, he, he's like the good and the bad. I mean, he's probably like impossible to get on. He has his own podcast and everything. But like I do listen to him when I'm trying to think, kind of trying to dissect it myself. And I think with with peptides, it's like look at how long some of them have been out on the market and have never reached the level of usefulness that, like, for instance, GLPs have. You know what I mean? Like before seven, it's been out on the market for like 30 years. Yet um it hasn't ever even passed a phase two clinical trial. Yeah. And that says something. You know what I mean?

SPEAKER_02 31:36

Yeah, but you know what I'm wondering about that? And you you would know perfect about this. Uh huh. Passing the clinical trials, to be able to pass them, doesn't it usually mean that it has to be fairly consistent across the board? Like they need to see a certain amount of people that have the same amount of whatever to be able to put any kind of label on it.

SPEAKER_00 31:52

They have to be able to A, prove that they're not gonna hurt people and B prove that they are going to do what they say they're going to do.

SPEAKER_02 31:58

Ah, okay. So, like same kind of thing with supplements, like you don't really know.

SPEAKER_00 32:02

Yeah, you don't really know. And so that's the thing. Like, and if and these pharma, these pharma companies like big pharma, they are watching all of these trials and they're they are jumping all over the ones that are showing promise. So with something like BP 157, I feel like it's either I don't think it's, I think it's definitely not shown harm. So if my patients do want to try it, I'm like, okay, like go to that person that's gonna give you that BP 157 and see how you feel. Because again, everyone's so bio-individual, because I don't think it's gonna harm you, but I don't know if it's gonna help you beyond the placebo effect.

SPEAKER_02 32:33

Yeah, absolutely. Yeah, I think I think that's important. It's like everybody's different, like when it comes to those things. So yeah, I just want people to like understand it. And as I think as like I said, as long as the the education is there and disclosures there, then I just want to empower them to make whatever like good decisions for them, you know.

SPEAKER_00 32:50

Yeah, I'll see keep a lookout on like who might be good to talk because you really do have to be careful.

SPEAKER_02 32:55

You can't just go for someone that's trying to like that's why that's why in three years we still haven't done it, right? Because we're like really careful, you know.

SPEAKER_00 33:03

I I might have somebody in mind for you. That would be good. I have to like check it out a little bit more.

SPEAKER_02 33:08

Yeah, that would be great because I think that um, like you said, like I need to check it out too. And things that come across my feed, I'm like, no. Or if their name is like Dr. Bob, and I'm like, no.

SPEAKER_00 33:20

Well, there is someone in my area who um I haven't investigated all of his, you know, I I do know he prescribes um peptides. He was a former radiation oncologist and um very, very nice pedigree and everything. And he he seems like he's very he's kind of reasonable. Um I'll I'll check him out and I'll give I'll send you his name.

SPEAKER_02 33:43

Yeah, that's great. I would definitely be open to that. Um, and uh I think it's just about like you said, like somebody that's not like someone that's an actual doctor. Like you wouldn't believe how many people are like chiropractors or not doctors at all, or and and like and it's just and once I start digging, I'm like, no, like you know, I mean, no, I I believe it.

SPEAKER_00 34:02

The menopause grift is everywhere now.

SPEAKER_02 34:05

Oh my gosh.

SPEAKER_00 34:06

People that have zero credentials and have given themselves their own credentials through their own school that they started, and they're not even they're not even chiropractors, like I don't know what they are.

SPEAKER_02 34:15

There is a a chiropractor, I'm just gonna see you real quick. There is a chiropractor out there that has a massive following and he prescribes GLP one and tells people too fast, and then he takes them off them, then he puts it back on them. He is a chiropractor. And I listen, I love a chiropractor. Like, but I'm not gonna get my obesity treatment from them. Like, that's all you know. I know, I think like a vast following.

SPEAKER_00 34:36

I mean, huge, yeah. I mean, I'm sure because people trust chiropractors, yeah. Um, and I do, just not with them. They don't trust MDs. People start trusting. There's a huge, I mean, a whole other topic, but there's a huge, like, there's a huge movement to like not trust doctors who've done like I did 12 years of training plus then a year of my menopause certification, then my obesity medicine certificate, like the whole thing, and like, but you know, I saw somebody on Facebook the other day looking for an NP to do her gallbladder removal surgery, and she didn't understand why she couldn't find an NP to be her surgeon. People don't even know the difference, and they try they'd rather have an NP. So there's a whole thing there, but there was something I was gonna tell you about um the GLPs back to your subject. I forgot what it was. This is all our subject.

SPEAKER_02 35:24

We're basically a it really is like it's become because we have a community, it's become like how do I be the healthiest me I can be, right? That's what that's what it is, yeah. Yeah, but it started out with let's learn everything about GLPs, and then it became, yeah, like that's what we talk about, but we also talk about food science, like we also talk about the fat liberation movement, like we also, you know, like we really we talk about preventative cardiology, like we, you know, like we we again, so they're used to us kind of going off book a little bit because we've heard they know that we will not steer them wrong, you know.

SPEAKER_00 35:55

When you go up on attention, it's also it is what people want to hear. I mean, what we're talking about, what becomes interesting is really what people want to know.

SPEAKER_02 36:02

Yes, I totally agree. Yeah. So we just like as long as we're set in the stage and the disclosure is cleared, then yeah, I'm fine with it. And and usually here they are. So um, but I think I will tell you, I do think one of the problems is, and Amanda and I've talked about this a lot, um, with doctors, is that again, like from the beginning, remember, I was like talking to you about um how a lot of times people don't want to go to their doctors, and it's because we've had this about face, right? And and while that about face is very, especially when it's coming from an obesity specialist or an endocrinologist, right? Like in those areas, it's very jarring and and very freeing to understand it's not our fault, right?

SPEAKER_00 36:38

Do you oh so you you're talking about the about face that doctors used to say, like, you know, extra. It's your fault or eat less, it's your fault, willpower. And now all of a sudden they're like, oh, this is a chronic disease. And yeah, I see. See, I feel like the the I feel like still most doctors don't even like they still even have PCPs don't chronic disease.

SPEAKER_03 36:57

Most don't.

SPEAKER_02 36:58

Yeah. Yeah. It's only, but in general, and I like even when I interviewed the woman from the fat liberation movement, uh, who works like from she's actually quite lovely. And she we she said, Kim, I I'm gonna do your show because um I think we have the same values, I think we just go about it different, you know? And I was like, Yeah, and she and and she takes GLP for diabetes and she was lovely and she's a civil rights activist, like she works with organizations so that if you live in a big body, because we I think you and I both know some people just after this still live in big bodies. I'm an example, you know. And um, and it's just nice that she's like, Look, like if your kid can't, you know, um doesn't have a desk at school that he fits in, I'm gonna make sure he does, you know. And if um, you know, and if I know I can't even, you have to watch that episode. It's like the best. Um, or if, you know, the US Navy won't hire you for a job because of the size of your body when you could definitely do that job, then I'm gonna work to try to, you know, make because it's a big employer, like I'm gonna make sure that that happens. Like that's that's what she does, right? Is like it's the whole idea of that you live in a fat body, right? You know, there's no cure for this, like you should be able to have opportunities as well. And so when I and I gave her that space because I was like, I know there's more here than just we want to stay, whatever, right? It's and there was, there was so much more there. And so I think like it's important that we have these nuanced conversations because it is what people need to hear. Like we we cover all of the things that are science-based and evidence and all the things, but as these things come up, people need guidance. And the guidance could just be we don't really know, but this is what we think, and that's okay, right? So I think um, and that's what our show has has morphed into is that we just want to make sure they have all the information out there because there is so much misinformation out there. But I think the ones that will prescribe it, like the ones that are uh specialist, um, you know, um A bomb specialist, whatever it may be, you know, they even them, it's hard for them to trust it because forever they have they have blown us off, right? And then even the world and society and industries that have been giving us all these diet pills have also preyed on us. Like that is true. That is true. And so what happens is they end up coming to me because I'm online instead of you. But I don't think that we're gonna get anywhere if we don't heal that trust relationship, right? And so that is why Amanda and I, and what we're doing, we're trying to bring us together, right? Because then we can get to a better place and we can advocate, and to her point, because she has this advocacy framework, right? Um, we can advocate for what it is we need and get the doctors there further, right? And um, and then get what we need. And I but I think that's the only way forward. We can't just continue to stand at odds, you know.

SPEAKER_00 39:40

No, one one thousand percent. Like I'm I I love what you're doing, and you're a hundred percent right. So you're so right. And I didn't actually realize, but I didn't realize that was going on where there was a mistrust because of a change all of a sudden in the way when what doctors were saying. Like, I I all of a sudden just thought when I heard about it and when I started learning about it, I was like, This is what I've always thought. Like, yes, this makes sense. And I thought it would just kind of click like that for everybody. I didn't realize that it was, yeah.

SPEAKER_02 40:11

Yeah, it's really intense.

SPEAKER_00 40:13

Um, so well, I I try to like I really try to like start get that trust going back, like on even on my little social media. I'm just like, you know, I I realize I'm in rarefied air though. The trust starts with having time to talk to patients, yes, and doctors are what we do in that you guys do, yeah. Yeah, so I love that you have a lot of doctors on your shows and give us that chance to like really have that in-depth conversation.

SPEAKER_03 40:39

Well, and you also said that you spend 90 minutes with your patients. That's not the average experience. Yeah. Well, so you're already doing that right.

SPEAKER_00 40:50

I am here, but this is rarefied air. I do, I have a love and hate relationship with the fact that I am a concierge doctor. Um, my patients, I do not take insurance in my my whole um career over 20 years. I was in an insurance-based medicine, and I was, you know, owned by a private equity company, and we were seeing patients every 15 minutes and had to double book ourselves every 45 minutes. So yeah, and all my patients were in perimenopause, and that's a long conversation. So I would have to run about an hour late every day just to be able to get that conversation in and um was kind of really stressful. And then when I had to leave that job and I was I was offered another position out of out of private equity, when I told them I wanted an hour to see patients, I never heard back. So I had to start my own, yeah, I had to start my own practice and I had to go outside of insurance, but I love like, but anyone that asks me to talk anywhere, like your yoga studio, your living room, your your church, your synagogue, I go, I go free of charge. I want to give, I want to, I want all the you know, the obesity, the menopause education out there.

SPEAKER_02 41:58

Well, that is going to help heal this relationship. Like you could come. So we have doctors come in cozy butter. I know we'll tell you why it's called that later, but you should come. And we like our our one of our doctors, um, that are is our friend and been on the show many times, just came and just gave an hour of her time. And I was like, look, like you come give an hour of your time. We're gonna make sure people know about you, we're gonna link your socials, we're gonna link your practice, like because we know that you have knowledge that we don't have, and also we know this is a way for us to heal, and they need to be able to ask these questions. So if you want to do that, open invite. Oh, put me on the list. All right, great. All right, go ahead, Amanda. Sorry, I know we squirreled off a little bit.

SPEAKER_03 42:36

Oh no, you're okay. I think that it'd be really interesting to learn a little bit more about um what you think about telehealth providers and what patients should look for when it comes to telehealth providers.

SPEAKER_00 42:47

Okay, I will start out by saying that I do think that this medicine should, if you can, if you have access, it should be done in person because what we do here, for instance, is I have a gym downstairs in my in my office. We're in my office now, and we have and I have a trainer, and it's funny because her her her name is also Kat, so we're Kim and Kat also. And um she is she I I get everyone on the body comp in person and I weigh everyone, especially when I first start them out. We do weekly check-ins, but we weigh every every month, and that that happens in person on a on a pretty validated body comp scale. And then I have my patients do weight training with my trainer who I trust is not going to injure them. However, that's nice. Yeah, it's really good. Like I've seen patients gain muscle while losing all fat, which is not an easy feat. So, um, so but having said that, not everyone has most people do not have access to that kind of care, and I get it. Absolutely fine. Most people don't even have access to like a weight loss doctor in their area that they can trust.

SPEAKER_02 43:51

So that is correct, especially in rural areas, yeah.

SPEAKER_00 43:54

Right. So I I will say that like in absence of that, telehealth can be okay. And the, you know, I think like I do have some patients that are, you know, like in college and they, you know, I tell them, okay, you this is the body comp scale I want you to get. We're gonna do telehealth. And when you come home for your holiday breaks, we'll get on my scale, we'll have a sit-down. But like we do primarily to through telehealth, we do weekly and monthly check-ins, and they are sending me their body comp results every week to every month. I'm monitoring their, you know, I'm able to totally do it um online with them. So I absolutely think that the benefit is in being able to get the medication and get it responsibly. And if that's through telehealth, then do that. Absolutely do that. I think go ahead, go ahead.

SPEAKER_02 44:36

I'm curious what we've seen. I know I I love that you're I mean, everything you're saying is like best practice, but you adjust accordingly, um, which I think is wonderful. Um, um, keep going. I'm curious what you've seen because like we talked about kind of this being the Wild West right now, right? It is. Um, yeah. So tell me what you've seen with like other telehealth providers. I probably think I got excited.

SPEAKER_00 44:56

I have seen this with telehealth and not even with telehealth. There's even an obesity medicine doctor around the corner for me, and she's using only compounds. And I've seen people come in here on what they think is 15 milligrams of trceptide, not losing any weight and not feeling anything. It's so that's that's pretty rare. And then I'm like, okay, well, let's just start you on the the branded Eli Lily, what you what you should be on, but I'm gonna half that dose just in case you're not getting what you think you're getting. Like non responders are rare. And I halved the dose to 7.5 milligrams, and she could barely eat for five days. So the compound. Something that happens with some of the telehealth, with some of the even in-person providers, is absolutely out there and dangerous. They are getting diluted medication. Sometimes they're getting contaminated medication. You know, there's that there's just not a lot of oversight in comp in some compounding pharmacies. So I've seen that all the time. I've seen a lot of patients come in with from like having been getting it from their local. Every plastic surgeon in my area is doing compounds, you know, because that's the only way they can make money off of it. If they could prescribe the safer, um, more reliable branded medication, but they're not because they need to make money off of it. So that's what I that's in my in my mind a red flag for telemedicine companies. Go to a telemedicine company that's giving you the branded Novo Nordisk, you know, Wagovi, or the branded Zetbound from Eli Lilly. There's no reason to be on a compound unless you really, really can't afford the branded in where from wherever you're getting it. Then I then I'm gonna say, like I said, there's a huge benefit like having suffered from obesity myself. Like I, when there was a shortage and no one could get GLPs, I transitioned to a compound for a while because I did not want to go off of it after having such success for two years. So if you can go to a, you know, if you can go to a more, you know, a more reliable compounding pharmacy, which is hard, but you know, I I went off on a tangent there, but I think that's a good flag for, I think that's a red flag for any any provider in person or telehealth. And there are telehealth providers that absolutely now it never used to be this way, but now are actually getting giving the branded um medications. Yeah. And if you can find a telehealth provider that is also going to have a dedicated person for you to be able to check in with your body comp that's requiring you to have a body comp scale and to give them measurements. Because pounds can be like, you know, if you're if you're talking to someone that is not exercising, someone that does suffer from obesity who has not been exercising before and they go on this GLP, it's like a magic medication. Like you don't, once you aren't constantly thinking about food anymore and that switch is turned off, you can, without the proper guidance, be totally enamored with the fact that you don't have to eat. You can starve yourself and you and you have you have dysfunctional um, you know, relationship with food your whole life. And finally, you don't you don't need it all the time. And you could be like, I could lose weight really fast if I just barely eat anything a day. And I've seen people do that. So I always, you know, your telehealth provider has to be telling you the goal of a GLP is not to never want food. It's to the goal of a GLP is to keep you hungry for all of your meals during the day. You should be hungry for three meals a day. You just shouldn't, you probably will not be eating as much, your portion size is going to be cut down, and you shouldn't be thinking about your snacking. And hopefully you shouldn't be thinking about the sweets as much. And I think gradually it will steer you away from the heavier meals, the fat-fried, fattier foods just through like negative um feedback when you don't feel as good when you take them. But like, you know, if patients aren't being given this guidance by their telehealth provider about how they should be eating, you know, one meal a day is not enough. Thinking that you're gonna lose, it's gonna like thinking about fast weight loss versus a slow, steady, healthy weight loss is not is not good. And so they they should be cautioned, like every everyone out there should be cautioned that you know, fast weight loss leads to like um, you know, the hair loss that no one wants, the muscle loss that no one wants. But also what happens when you lose that muscle is that you slow your metabolism down. And when, you know, muscle burns so many more calories on a basal level, like even while you're sleeping. Like, who doesn't want to lose weight while they're sleeping, right? Yeah. So um, so losing that muscle is gonna slow your metabolism. And then you're gonna hit these long, hard plateaus where you're gonna be faced then if you're not getting the proper guidance of do I just up my GLP and try to starve more? And that's not gonna work, right? Yeah. Yes, exactly. So important. So if all those things, everything you just said. Yeah. So if you're going to a telehealth provider that is just sending you the medication and then you're out there on your own, red flag, red flag. You have to be finding one that has that that is giving you the nutritional advice that's telling you how to, how to, um, you know, how you should be eating, not starving. You know, there just has to be guidance and there has to be monitoring.

SPEAKER_03 49:58

Can you give us some examples of what kinds of foods they should be eating once they're on this medication?

SPEAKER_00 50:04

So every single meal, I think, should have a protein source and a fiber source. So, like, I have, you know, I think there's a natural progression for for me. And I'll use myself as an example. I was an unhealthy eater. It was, you know, when I went to my obesity medicine specialist and they had me fill out a checklist is like, is your portion size too much? Yes. Do you eat in-between meals? Yes. Do you eat after 7 p.m.? Yes. Do you eat a lot of sweets? Yes. Do you eat? I mean, everything was yes. And it was so, it was so embarrassing, actually. And um, and I think that what I first did, even though I was getting guidance, so you know, we're all human, is that the first thing I did being a physician working 90 hours a week and having two young kids, and I was a single parent, like I just kind of de let the Zet found do its job and I decreased my portion size of probably the crappy food that I was eating, right? Honestly, I did too, and I don't think that's bad. It's fine.

SPEAKER_02 50:58

It's it was a non-diet culture way to do it. Yes. And then when the food noise was gone, I assume this is probably the same as you. I had the ability to be more intentional about my food and wanted to, and also be more intentional about my movement because the weight was gone, inflammation was gone. It I got in just like a good few months, yeah, good place, and then I started on those things.

SPEAKER_00 51:19

Right. That's exactly what happened to me. And I tell my patients, my patients who are coming in and they're they're in the obese range. I'm like, this is okay if this happens. I got this is what I like to have happen. Like, and I give them my whole, like a whole, you know, not a meal plan, but just like, this is the kind of food that you want to eat. You know, you want to you want to be concentrating on proteins, like lean proteins. You know, um, we love chicken, we love fish, I love all sorts of vegetarian sources of of protein. You want to include, you know, you want to include a vegetable source in every meal. And I need a little bit of cards in every I could do one meal. I mean, I'm not saying eat salads. Like usually if I eat a big salad for lunch, the salad is out for dinner, but I have a vegetable for dinner, you know what I mean? But like the fiber is so important in controlling like glucose, okay? And you know, it I sometimes I did myself and have some of my patients wear Dexcoms and stuff just so they can understand the order in which they eat foods and how that affects their blood foods, blood glucose and how when they eat carbs at night versus in the morning. But I try to give them this is the ideal way to eat. But I say, listen, if the only thing that's gonna happen in the beginning is that you're just gonna cut down your portion size and cut down your snacking of your of your pizza, of your pasta, it's okay in the beginning. But in the end, we're not, we're gonna, we're gonna be elsewhere. Even in the middle, yeah. I agree. Yeah. Yeah. So like for me, it was like that stepwise progression of like, you know, then I was like, then I then I got to under a certain weight and I started feeling like I think I could go back to the gym now. Like, I don't feel so ashamed of my body and like so I'm so like self-conscious. And I got back to the gym, I started walking, started yoga, eventually started my weightlifting. I started learning that when I ate these bad foods, I didn't feel as good. And for a while it was like, oh, why did I just eat that? I knew that was gonna be, I knew it wasn't gonna make me feel good. And then that morphed into like, I don't even want that anymore. And my diet is like 85% clean now, and 15% I still eat my ice cream and you know, suffer the consequences.

SPEAKER_02 53:16

Yeah. Most GLP1 providers write your script and then wave you off and say, just diet and exercise. And if you're lucky, you'll actually get someone that'll help you understand how to manage your side effects. If you listen to this podcast regularly, you know that as an obesity care advocate, I believe that this journey is really complex and that you deserve better than just a weight loss program. Bell is different because they care both about community and the patient experience. They sponsor this podcast and they even brought me on as a strategic partner. I'm a Bell patient too. And if you use Bell as your provider, I can actually be part of your journey because I run a weekly patient support group hosted in their community. This is the kind of care that I want for you, and I'd love to see you there. Go to link.joinbell.com slash podcast and use code podcast at checkout to save. I hope to see you there. Friends, give me one minute of your time. I recently launched a community called cozybutter.com with my friend, fellow obesity care advocate, and now partner, Amanda Benello, and you can join it for free. After three years of interviewing obesity medicine experts and hearing from tens of thousands of you, I still see the same gap and support between getting your prescription and then actually getting whatever you need to achieve whatever your goal is. Having the food noise turn off can be incredibly powerful, but there can also be a lot of questions and a lot of fear in that space, in that silence. I see people flocking to social media hoping that the algorithm will serve them of something helpful instead of something misleading. Amanda and I are both tired of it, so we decided to fix it ourselves. Inside Cozy Butter, we have live support groups, health coaches, expert QA's, cooking and movement classes, recipes, side effect resources, calculators for your protein, your water, your fiber, even a protein meal builder, medication comparisons, so you can look at the ones now and ones in the future, all with trusted cited sources. And beyond all of that, we're creating a space for you to build real authentic connection because obesity is a chronic disease. GLP ones are amazing treatments, but they're not cures. So we're gonna need to support each other for years to come. You can join us for free today at cozybutter.com. You deserve better. You deserve butter. Welcome to the butterway. I totally understand. Like, and I do think like things in moderation are wonderful. Um and being able to actually control that as opposed to being driven so much by food noise that it's all you can do when you feel like you want to make a worse with it. It's the worst, and it's torturous, and it and also obesity hurts, you know. I think that I will tell you personally, I have tried both brand and compound. There are many benefits to compound in terms of I think like what you said around split dosing and microdosing. Um, I do think that I'm gonna be honest though, I think it's gotten out of control, and I'm only starting to, I have, you know, like um, it's not coaching, it's peer-peer support, advocacy education, kind of like uh one-on-ones. And one of the girls that's one of my clients um told me that she was ordering compound and that they had put NAD in her compound, her GLP1 compound.

SPEAKER_00 56:40

Well, they tried, they have to put something in it too.

SPEAKER_02 56:43

I know, but like why there is no argument to put NAD in your obesity medicine. I I really struggle with that. I I really struggle. And but I do think there's a very important place for compound, exactly what you just said. It's the affordability, the accessibility. It these things are still very expensive, and they shouldn't just be for the elite, they shouldn't just be for people that have insurance because millions and millions of people are sick. And here's the problem like if we don't have that, if we don't have compound that's very reputable, um, like and what I mean by reputable is like a 503A, 503B, right? Compound pharmacies. Um, and if we don't have that, then they go to gray market. And I have many followers that have been forced there because they can't even afford the compound. And it's not because they're, and there are some people that do it just for weight loss, but there are many, many people that are just really sick and tired of being sick and tired, you know, and if nobody will help them, they're going to help themselves, right? And so as we so that's why I think that gap of having it is really important for I think also the dosing piece, right? And I do think that there are things that they put in the like I think glycine like helps a lot with um some of the nausea and exhaustion. I think B12 can too. But again, we as you know, this can be not measured and out of control and all of those different things. And that's when it gets scary. But the thing is, is even the people that do gray market, I know I'm digging into some stuff here, um, do gray market, they're not getting it mixed with anything. They mix it themselves, but they're getting it from gray market. But it almost, I think, like they're always like risk versus reward when they're doing it, right? But can they all be taken advantage of and led astray too? Yeah. That's the population that people with obesity are in, right? Is that we can't afford to get better. Everybody yells at us for being sick, right? I mean, because they don't think we're sick, they just think we're fat and lazy. And then on top of that, we or we either can't afford the medicine at all, right? Or nobody wants to help us, or insurance doesn't care, or we don't have insurance. Like the issue is vast, and like the people that can't afford is like what 25%? Like, you know, it's so small compared to the amount of people that have this illness. And I I think it's because I've interviewed these doctors for so long. Keep in mind, I'm only telling you this because I'm trying to heal the trust.

SPEAKER_04 59:05

Yeah.

SPEAKER_02 59:06

Okay. All right. Um, but have um have dealt with this for so long, right? That they're just at the point where I'm and a lot of people are scared too, right? Because you hear all you you go on the internet and you hear all about the side effects, just like you were saying. Like there that is the almost easiest thing to control. And then that's another really good place for compound, right?

SPEAKER_00 59:26

Yeah, it's the easiest thing to control. You can microdose, you can even microdose like wakovi in an auto injector pen by putting it into a larger vial and then withdrawing a small amount of it. Like that's how I tell my patients if they get coverage for wagovi, but they don't have coverage for like trazepatine, which comes in the vials. Like I've had my patients, you know, and we used to sometimes do this in the clinic just to help patients with cost. Um, if we would get like, you know, you can you can actually, well, I don't know if I should say this in your podcast, but you can actually like auto-inject like the the medicine into a vial and then withdraw a certain amount and give a certain amount.

SPEAKER_03 1:00:02

No, you can, but not by yourself. Yeah, but not by yourself.

SPEAKER_00 1:00:07

You need the guidance, like yeah, with the colin. I mean, I have listen, I had a patient come in and she was getting a compound trisepatide and got a terrible food poisoning from it and didn't know it had anything to do with the food poisoning or the fact that compounding could be less reliable. And she was she had regained all the weight back that she had lost on it, 45 pounds, and was deathly afraid of trying it again. I'm like, listen, like I just don't think what I'm hearing from you after having been on the trzepatide for a long time, then all of a sudden it no, no, it this had to have been contaminated and we got her back on it safely and she never does compounding again. So listen, like you have to be open-minded about it because everyone should be able to have the benefit. You just try to help them do it in the safest way. And if they can't, if the if compounding is the only way they can afford it, you know, that's the way. But like I remember a couple, what was it last year? I was at the the um OMA, the obesity medicine association yearly meeting, and they had on the stage the like representatives from like Novo Nordisk and Eli Lilly, and then they had pharmaceutical on the PMB, the far the pharmacy benefit managers on there, and then they had like the um president of the insurance companies, and they were all pointing fingers at each other as to why these medications are not being made affordable to patients and like Eli Lilly should reduce the price, the insurance company should allow the coverage. Then they're all saying, Well, no, it's you know, your your employer's not opting in. And it's like it's just a big monopoly, and no one's taking responsibility, and insurance carriers, they don't know that you're gonna be on their insurance plan 20 years later to like they know you won't, they know the data shows you won't vascular seeds.

SPEAKER_02 1:01:47

Yeah, yeah. So like it's like three to five years. It's like, you know, yeah, that's probably even probably even less now considering like the job market, you know.

SPEAKER_00 1:01:57

Like I wish we had, I wish we just had a place to come, like a clinic to come get your GLP shots, government subsidized it. Like we would really um for the most part eradicate the obesity epidemic in America.

SPEAKER_02 1:02:09

I know, I know it would be like just amazing to get people, I think, just in a better place. I mean, I can't remember which country it is. I w it's somewhere in UK, somewhere or somewhere in Europe.

SPEAKER_00 1:02:19

It's like $30.

SPEAKER_02 1:02:21

Yeah, yeah. Well, like they reduced it. Like they well, some well, it's changed. A lot of them now have to pay what we have to pay, like the three, four hundred, five hundred dollars. But but before that, what they were doing a program, and then they again started to do it here with Bridge program, I think, with Medicare. Um, but they were doing a program to help people who to give the medicine to people who didn't work anymore, right? Because they were sick to see if they give them in a healthier state and measure the data to see if they would start working again and become contributing to society in that way, like financially, right? Which I actually thought was so sad, but also very brilliant because it is it is an opportunity, right? And I think that like it's it's sad though, like when I talk with my friends that are doing bridge program, like my if my mom just got accepted and she's been on the medicine for years, and so she's kind of just trying to get in, like, maintain what she's lost, and it's helped her so much. She's 71. And um, she just got accepted to it. And my friend and I, Didi, who Didi's her age and has been on my show, she was like, Debbie, you can't have them just tell you, right, that you that that the medicine isn't available. If they say we have to order it, if they're not gonna order it, then every day on this program, right, is a day lost. And you want to fill your your, you have to be diligent. Like you have to fill exactly when. If you have to call around pharmacy, you have to call around pharmacies. This has a time clock and you and and it is valuable and you have to have enough, right? And if you fill every 20, whatever days, right, then you can have enough and maybe last you longer. That's where we're at. That's what even our seniors are having to deal with. Like it is utterly disgusting. And the problem is, is now that trust is also being seen as doctors or their problem is blah blah blah. And so nobody trusts anybody anymore, right? And they're all getting it from China. I mean, that's just that's how bad it is. And like, so this is the things I'm trying to like get in front of people who can like make a difference because I'm like, you don't think they don't talk to our people, they don't they don't, or our people don't talk to them in the way they talk to us, right? Yeah, and so it's such a big, it's such a big issue. Um, and I think we're but I do see traction. Like I think men are both like we see changes happening, we see meaningful changes. It is slower than we would like, but if we really look at the fact that Wogovi was $1,400 a month four years ago and now it's $500, yeah, how how how crazy is that? That never happens in pharma. It never happens, right? But still, most people they can't do that. They still can't do that, yeah. And so, you know, that's I so what I just try to do is have a space and be like, I want you to follow best practice, I want you to get your medicine from a doctor, I want you to have a doctor like Dr. Einhorn, where she's you know, meeting with you and connecting with you and spending time with you, but I know they can't get that, right? And I also know that a lot of those specific things, if we bring doctors into our community, right, and then we echo those things out as we learn them, we can at least try to help solve for the problem now, right? Yeah, but that's our cozy butter community, you know, and and to try because we can't sit around and wait for people to fix it because it's just not gonna happen.

unknown 1:05:33

Right.

SPEAKER_02 1:05:34

And then people just get sicker and sicker and and then they die. I mean, that's just like, you know what I mean? Like I just I don't think people consider the fact that this is a a pretty slow killer and it's it's awful. And so I think we just see it different because we are in this space, we advocate, we speak with lawmakers, right? Um, and so I just I just I don't know how to solve it, but I do know we can't solve it apart. Right. You know, yeah, and so if like if people are gonna have to get their medicine from telehealth, then I want to be a part of trying to solve that. I want to need to come to the community, I want to run a support group, I wanna, whatever it is that you in between, you know, can say these things to me and I can tell you what I've heard that's best practice, I can tell you what I've heard other people do, at least there's something in the middle. There's no there's no middleman in this world, right?

SPEAKER_00 1:06:22

That's like such a good idea. Like for, you know, if patients are getting it from a cheaper platform, at least have a have a way to like, you know, like I like I would be happy to donate my time for like an hour on a Zoom to talk about like how you should get on it. Like, you know, for instance, when I tell patients when they're first starting, I always tell them, like, this is the time that you're gonna have the most side effects when you onboard and when you increase in dose, right? And so I say, like, for the first, you know, for the first, for the, let's say you're gonna do your um, you're gonna take your dose at night, make sure you eat light and easily digestible foods through the day. Don't just like have a huge dinner, take your shot, and then the next morning you're gonna be feeling that because your GI motility is still gonna be slowed by that point. Or for the in the same respect, like if you're taking your dose at like at like four o'clock and you're not feeling it yet, you eat a huge dinner. That is not, you don't know how you're gonna react to that, especially when you first start. So, like I just give my patients a lot of counseling around how they should eat in that 24-hour period around the time they take their injection. And that even makes such a huge difference. Like it does. That's what they come to us for. Yeah, and they're not getting they're not getting that that education. And you know, even like even the people that you know that will that will feel tired and have a headache, and then you find out they haven't eaten and it's three o'clock in the afternoon. Like, you have to be mindful. Sometimes I'm like, this might make you feel like you forget to eat, which is totally foreign to them. And I want them to understand that's not the right thing. And if you have to set an alarm, like you either have to lower your dose or where you have to set an alarm, you have to eat to avoid those side effects. So, like, you know, I'm sure there would be so many doctors, like myself among them, that would be happy to like do a webinar, like have as many people that are like starting GLPs without the right guidance to do that for them, you know?

SPEAKER_02 1:08:07

Well, it's a lot of different things. So our community really, I could look at the journey in different phases, right? And so I tell Amanda all the time I'm in phase four. And phase four is I was maintaining what I lost, but still needed to lose more, quote unquote, right? Because I have severe obesity, like in insulin resistance, all the things, right? Um, and I think that a lot of people don't understand, and maybe we can touch on that and we can finish out our time together, but um, don't understand stalls. They don't understand like plateaus. It's probably over or it's going to be years, and you're probably gonna need like additional medical interventions. Um, I don't think they understand that. I don't think they understand switching agonists. I don't think they understand that this is gonna be like a moving target and why. Um is is that something that you can touch on for us? Um you've been prescribing for a long time, right? So I I I can only imagine that you've like had to change things up, right?

SPEAKER_00 1:08:59

I do have to change things up, um, you know, because the medication, it really depends on it, depends on, you know, what you're coming in with. You know, uh absolutely the, you know, you know that you're gonna lose like potentially 21% of your body weight on a terzepatide, a little bit more on a renatru tide that's coming out like first quarter 2027. Um, and sometimes that's enough for people, sometimes it's not gonna be enough for others. The stalls happen because, you know, I I your body can become accustomed to the GLP and sometimes can like override it. And that, you know, that is unfortunate when that happens. But the stalls also happen because people haven't been concentrating on muscle building. You know what I mean? So, like we talked about before, if you're not but if you're losing muscle, you're lowering your metabolic rate. If you're not eating enough, which means you are burning less, yes?

SPEAKER_02 1:09:50

You're burning less calories.

SPEAKER_00 1:09:52

Like we've all heard, we all know, we've all heard muscle burns more than fat, right? Yeah, and that is true. Like muscle is the most metabolically healthy, most useful tissue in our body. And the more muscle we have, the better our blood glucose regulation is, and the higher metabolic rate, the more calories we're burning per hour, right? Yeah, and so when we when we lose a pound of weight, it's usually never just fat. It's muscle, it's water, it's fat. And on average, it can be 25% muscle. So that's what you have to try to curb. And the only way to do that, or the only way to curb that is to make sure you're getting a good amount of protein. So, and that depends on that depends, it's different from person to person, but it's usually dependent on how much you weigh and what your ideal body weight is. But you cannot be getting a lot of people are getting less than 60 grams a day. That's like protein malnourishment. You have to be aiming for a minimum of 80. I mean, my patients that have had the best results are getting over 100 grams a day of protein, right? Yeah. So you have to be eating adequate protein and you have to be maintaining and hopefully building your muscle. And then that is the way you're gonna be able to avoid the plateaus. And under also understanding that plateaus happen naturally in weight loss because the other reason why we lower our metabolic rate, our how many calories we're burning, is because when we lose weight, even one pound, our bodies don't know that there's our bodies don't know that there's a supermarket down the we don't know there's a Whole Foods down the street, right? It it thinks we're hunter-gatherers. So it's gonna try to maintain that weight on us um as a survival mechanism. So it's gonna do two things for, you know, for for for me and for most of us that suffer from obesity, it's gonna tell us to eat, eat, eat. And that's why it's impossible. It's very hard to maintain weight loss. 90% of people who do it um through diet, through diet are going to regain that weight. And it's also going to slow our metabolic rate. It's gonna stop us from burning calories at that same rate. So, you know, we're we're kind of fighting double whammies of like slowing our metabolic rate through losing muscle and through just eating less. So the muscle can be the muscle can be um modified. You know, if you're gaining muscle, you're gonna really help get you through those plateaus, but the plateaus are natural and to be expected. And usually just by staying on the medication and riding them out within two to three months, you'll start seeing another phase of weight loss. Now, the other thing is when that doesn't happen. And then sometimes that is switching to a different GLP and that that may work better. Um, I definitely have seen people switch from semaglutide to terzepatite and start their weight loss again. And I've seen it happen in the reverse too. Even though semaglutide has less of a percentage of body weight in the studies, sometimes that works better for people, sometimes it's through the nausea mechanism, unfortunately. Um, but I've also then, you know, added added medications on. We've added, we've added um Q semi on, we've added penteramine on. Um, but I don't like to do that if the patient isn't doing what they should in their lifestyle pillars. You know what I mean? So that's the that's the key that I feel like it does become easy to just be like, what else can you give me, Doc? You know what I mean? Yeah. So, you know, there has to be, there has to be like effort on patient side, effort on doctor side. You know what I mean?

SPEAKER_02 1:12:59

Absolutely. This is where the trust comes in, right? Like, yeah.

SPEAKER_00 1:13:03

Like, you know, I I know if you're I know if you're exercising or not because I see your muscle every month. Yeah, you know what I mean? And so you can't fool me. You can't tell me, oh yeah, I'm lifting weights, but your muscle keeps going down. No, it's it doesn't work like that. So I know there's accountability to it, and that's where it comes in. You know, there has to be some time in your day that you find to do something little every every day.

SPEAKER_02 1:13:23

Yeah. I think the the hardest thing I have found was being able to maintain it once I lost it. And I found that everything in moderation was really, really difficult to keep it off. I had to be way more diligent, and I had to, even though I was I was exercising every day. Right. Every day. I but I'm well in all fairness, I'm also going through the the thing. On what? Yeah, the the menopause. Like I'm also like everything's changing, right? So everything's like when it started to come back on, it was all in this different areas and all that stuff. But regardless, uh, and then stress, and then I told you experienced loss and grief and all these things in this time span, which all affect different things. But I'm here's what I want to ask you. I would like for us, because I'll tell you what happens when this when they hit these, when they hit the either stalls for and when I when I mean stalls, I to me it's like a couple months, right? When I say plateaus, I mean you've and maybe I'm wrong, so you can please correct me if I'm wrong, because I don't want to say the wrong thing. But it's more like you've hit where you're going months and months and months, and you've probably capped out what you can do on the medicine in terms of like um in terms of um the dose, right? Or the percentage loss that's in studies, like you've capped that out, right? Because people think, well, if I continue my nutrition and my movement that I'm going to lose more. And that's often not the case, right? Like oftentimes, right, oftentimes you do, especially how if you've had severe obesity a long time, right? That's not the case. So what happens is, and this I really would look for, I think you can explain this well. When they when that happens, in my comments, this is what lives there. I've lowered my calories to 900. I've lowered my calories to 500. And it's not work, that's what they're doing. They're yeah, that's part of the problem. That's part of the problem. Can you tell us why scientifically? That's part of the problem.

SPEAKER_00 1:15:20

It all goes back to starvation and how your body reacts to starvation. So I have a lot of patients that not a lot, but I I have definitely had patients that are not losing weight because they are in too much of a calorie deficit.

SPEAKER_04 1:15:34

Yes.

SPEAKER_00 1:15:34

And when you're not, when you're not giving your body what its basic needs are, then your body is going to shut down, it's going to think it's starving, and it's going to start reserving, you know, it's going to slow your metabolic rate down to the point where you're never going to lose that weight anymore. And actually, my patients have had success in discovering that they can get over a plateau by gradually then increasing their amount of calories. I mean, it's so counterintuitive, and it's so counterintuitive to people like that have had dysfunctional eating their whole lives. And you initially see how much weight you lose by cutting your calories because that's what happens. And that's true. Like, and we we hear from like reputable doctors all the time calorie deficit is the only way to lose weight, and it's true.

SPEAKER_02 1:16:18

But there's a gym bros, whoo, whoo, you wouldn't believe what they're telling people.

SPEAKER_00 1:16:23

And diet culture is thick out here. Right. You know, it's true to a certain extent. Like if you're eating 4,000 calories a day and you cut it down to 2,500 calories a day, of course you're gonna lose weight.

SPEAKER_02 1:16:33

You're going to, but you know Hey, have you remembered to comment, like, subscribe, share, click the reminder bell wherever you're watching or listening to this podcast? If not, please do it now so that you can help us grow and help more people. We love you. Hope you're enjoying the show.

SPEAKER_00 1:16:47

You know, when you cut it down to below the bare requirements of what your body needs, your body's gonna shut down because it needs to survive and it's gonna just slow that metabolic rate to a point where you're never gonna lose weight beyond that. And so patients can get over that by increasing the amount of calories they need to like the, you know, over the bare minimum. Like I don't, I tell my patients like you shouldn't really, there's no ever reason to decrease calories beyond below 1200 and even preferably more than 1200, depending on who you are. I mean, every patient's different and they have different caloric needs. But I mean, if I ever see anybody eating less than 1200 calories a day, and especially they're stalled, I know why. My trainer knows why, you know what I mean? She knows, like she, she, and we talk about patients, we have like meetings about patients that we think are in a little bit of trouble. Um, you know, why they're why all of a sudden they're not being not able to lift as much in the gym, why they're hitting weight plateaus, it's because they're not adequately fueling themselves and they're not they're also not meeting their protein requirements.

SPEAKER_02 1:17:47

Yeah, yeah, absolutely. And I think this is a big part of it. And here's where I think the rub is that we need help with, okay? As patients, because diet culture is so thick and all this stuff is on the internet and all those other problems we mentioned in the beginning, right? When we hear scale and when we hear words like accountability, and when we hear words like lifestyle change, right, we hear stuff we've heard all before. When we hear exercise, when we hear diet, all those things that have ever plagued us, like if you look if you look at the state the data of like what people search for online, one of the most common terms is what do I eat in a day? That's how bad it is. None of us even know anymore. Yeah. So they don't, that's how you know, and and and nobody's giving the guidance. That's why they're searching for it. That's why it's like this permission-based search. So I feel like there's an opportunity for us to use some different words, right? Where it isn't triggering, because it's it is right, like it's and I know that we can't avoid triggers for everyone all the time. I'm keenly aware of that. But these ones are big ones, and unfortunately, that's what we call them. And I think there's an opportunity for us to work on the language a little bit better and get more compliance. I really do. I wish, and I agree. Talk about your nutrition. Let's call talk about your movement. Hey, listen, the scale, right? This is the this is a big mental piece, right? The scale is meant for us to just track your health so we know that you're okay. Like there, there are other ways to say it to get people in a place to receive, right? Yes. And I think that people would be more compliant and feel a part of their journey and a part of the care. And if they don't, then they're gonna go off. Like that's just what we're seeing, right?

SPEAKER_00 1:19:24

When I try, when I tell when I ask patients if they're ready to get on the scale, because I talk to them for like, you know, the whole visit and the scale is usually the last thing because I never want to test anything on the scale before I even know them, you know. Yeah, yeah. I don't know what baggage they're coming in with with the scale. And, you know, of course, there's like this visceral reaction to the scale. And I said it has nothing to do with pounds. And believe me, when I put you on the scale, I'm not even gonna remember what that number says. It's just about I'm looking at your fat and your muscle, and I'm making sure that we're, you know, I want to see where we are with that. And that's what we're gonna track every time. And it has nothing to do with pounds. Like I have patients who are overweight, but they're actually overweight because they have so much muscle. I have patients that are that are actually a normal, they, you know, they're they're a normal BMI, but they're completely unhealthy because they have so much fat, but it it it weighs less than muscle, you know, things like that. So BMI and weight, we really have to. I I I don't like those words. I don't like the pounds, you know what I mean? But um, I do try to it's less even about pounds.

SPEAKER_02 1:20:18

I mean, we all we all throw pounds around like crazy. It's more about the diet and exercise. That's been the prescription literally our entire lives. And you know, and we tried that, you know.

SPEAKER_00 1:20:29

It's so daunting. And I try to tell people it's daunting. And I with with exercise and diet, I approach it like this. I say, like, think about the things that you need to add into your diet to try to like make yourself more healthy. And the more of these healthy things you add in, the less room there's gonna be for the other things that you need to eliminate. And I don't want to use the word eliminate, the less room there's gonna be for the things that aren't gonna serve your health very well. You know what I mean? Like, just add in, add in. And for the exercise, like, listen, I know if I told myself, like, there's certain exercises that I like to do, but I just can't do them all the time. I can't go skiing all year round. I can't, you know, get on my paddleboard all year round, I can't do fun things like that. I don't even have the time. I'm in here in the office all the time. I hate getting on the treadmill, but that's something that I can actually do very easily. And if I tell myself, I'm gonna get on that treadmill, I'm gonna run for 30 minutes, or I'm gonna get on for an hour, like I'm not going down there. But if I just yeah, if I tell myself, like, I'm gonna get on that treadmill and I'm gonna walk for like 10 minutes, you know what I mean? Or five, something so easy that it's like, of course I have five minutes, and of course it's gonna, I'm not even gonna break. It'll be fine. Like, I'll get down on that treadmill and I'm setting a really kind of low goal for myself. But then I know once I'm on the treadmill, I'm probably gonna walk a little bit longer than I told myself, than I bargained myself to get down there. But like, I don't tell myself that's the goal. I just tell myself, like, I'm just gonna spend 10 minutes walking on this treadmill and I'm gonna put a show on that I like to watch and it'll be fine. And you know, I just don't, it doesn't have to be about killing yourself, challenging yourself. It has to be about something that you can do on a consistent basis. And if it's not overwhelming and daunting, then you're more likely to do it. And that's where the benefit comes in. Yeah.

SPEAKER_02 1:22:11

Yeah. That's what I tell people a lot too, because I think the common misconception is that because we think that um building muscle has to mean going to the gym and lifting heavy. And that we don't have to, we don't have to do that, right? Like, I mean, I'm not saying that people don't love that, but I'm I I have a kettlebell, I have resistance bands, I go up and down the stairs, like I do all of these different things to use my body as resistance to build muscle. And it's very doable throughout the day to be able to do that, right? Yeah. And and I think that a lot of people, especially in the beginning, if they're dealing with being in a bigger body and they're hurting and they're just getting to a place of inflammation control, which is why you and I talked in the beginning about the diet thing, right? Right, just eating a little less to start. Like prioritize your protein, eat a little less, you know, right. Because it does, as you go through this journey, you do have to adjust those things, right? But the last thing they adjust when they're at that the every single time when they get to those stalls, they're like, I should eat less and exercise more. And at the end of the day, you and I both know there's a like you just said it, right? Like there's this place there. And if you do that too much, not only is your body gonna fight you, but what's it gonna go for if you're eating too low and it needs to eat? Is it gonna go for your fat or is it gonna go for your muscle?

SPEAKER_00 1:23:17

Yeah, absolutely. It's gonna, it's gonna go for both.

SPEAKER_02 1:23:20

Yeah.

SPEAKER_00 1:23:21

And so then it's like, you know, it's not really gonna like, it's definitely going to it's never gonna give you the outcome that you want as far as weight loss, pounds on that scale. You know, if you're if you're certainly not maintaining it. No, the main the maintenance comes, the maintenance comes with patience. And um, and I do tell my patients, like, you know, if you're doing all the right things, for the most part, plateaus, riding them out for about three months, you know what I mean, is really all it takes. But you know, there has to be some consistency in exercise. If there, if I see you losing muscle, I know that's why you're plateauing. Um, there isn't like for patients that aren't really exercising, um, anything is gonna build muscle for them. Like, even even for someone that hasn't been walking, like I have a patient that literally did nothing and her muscle was off the charts. It was like a sarcopenic obesity situation. Yeah, and um, sarcopenia meaning like um deficient in muscle. And that's a really metabolically dangerous condition to have. So, you know, like of course, like she can come lift weights with my trainer at the gym and everything like that. But like really what she just started doing was she went out and she put a couple, like little couple two-pound weights on her ankles and on her wrists, and she just started walking. And I saw tremendous improvements in her muscle just from something little like that. Now, if you're coming in and you're already a weightlifter and you already have this certain amount of muscle buildup, the only way that you're going to build more muscle is to increase the weights that you're doing. Like it's different, you know what I mean? But it's all so, so it's different for everyone in what they need to do. And I have everyone on the spectrum here, but it doesn't always have to be like lift heavy, lift to five rep max. Like no, no, yeah, yeah.

SPEAKER_02 1:25:03

And they don't know, and nobody tells them. Um, you know, and uh they're getting it from their PCP, they give very little guidance. I mean, sometimes some PCPs are just amazing, right? Yeah, they just really understand, you know, but and I'm seeing more than medical school, we're just not talking about school, but it's just so hard, it's so it's so it's so like complex. And I feel like I mean I know a lot about it because I talk to you guys so often and I learn from you. But like when if I were to go and get on a scale, first of all, I would freak out. Um, but if someone were to say to me, hey, in the beginning, I want you to get on the scale because I just want to get a baseline because I want to take care of you.

SPEAKER_04 1:25:42

Yeah.

SPEAKER_02 1:25:43

Like if someone were to say that to me and go, Do you know that obesity is a chronic disease and it's not your fault? The level of me being able to receive, right, the care that you're trying to provide, and the level of me wanting to be compliant with that care because I understand it, and we're not talking over my head, right, or behind my back. Like if if that piece of it could be part of it, if it was, hey, we're gonna talk about nutrition and then we're gonna talk about different ways to move your body. And if you want to do muscle, these are some really good ways to move your body. And when they're like, Well, I like to swim, great, swim, but you know, you may want to do this too. Like the guidance and the structure of that conversation, like could be so powerful for us to be to again like be in a place to receive the therapy you're trying to provide us because we are mentally like, you know, we have to understand.

SPEAKER_00 1:26:38

I mean, you know, a lot of listen, I I I I assume that doctors that suffer from obesity themselves are a little bit more sensitive, but we don't, I mean, the language is the language of how to speak to the language of how to speak about obesity is really deficient and still is developing. And um, it's very hard. It's really hard, but you know, it's it's it was easier for me. Like I didn't spend my whole life being obese, but I certainly developed it in my mid-40s. And it definitely made me like I found all of a sudden my patients were so much more receptive to talking to me about it when I was when my BMI was 30. Yeah, like when you were trans, because because they knew you understood. Yeah, I did. And even if I didn't look, even if I didn't look at before, because I did have a period of my life where like I didn't, I didn't have, I wasn't overweight my whole life. I would have at every inflection point in my life, and this is something after going on GLP that I would look back on at every different change in my life, like freshman year of high school, first year of college, first year of medical school, within two months I would gain 20 pounds. And then I would like, then I would like switch it back, starve myself, I would lose it. And then in my 40s, I had like an accident and I stopped exercising, and then I was like in perimenopause and I gained 50 pounds and I couldn't lose it. Like I couldn't lose it. And you know, then I, you know, and after years, like in three years, I gained 50 pounds. And then I finally found a doctor that would help me. And then when going on the GLP, it was like I looked back on my whole life and I'm like, I've always had this brain, and not everyone has this brain, but I've always thought like this. And I never thought about myself like as someone who suffers from obesity, but I always did. And I have patients that come to me and they're they tell me, like, I don't want to lose weight, I'm actually okay where I am, but I'm bad. I'm killing myself to do this. Like, and they benefit from a microdose or a GLP, you know what I mean?

SPEAKER_02 1:28:31

And whatever it's I totally think that's true. I can't wait to see the studies on it. I when I had that preventative, so I had this preventative cardiologist um from the American Heart Association, I think it was in the beginning of the season. And he was like, This is, I'm telling you, like most of this just genetic, and it's been brewing forever. Like it's it's absolutely. Yeah.

SPEAKER_00 1:28:51

I tell my patients, and and you you see they the tears like of relief because they've been so spent so long, so their whole life in shame that they're less than. And I'm like, this is genetic. My father had obesity, my sister had obesity, like it's genetic, and the genetics cause your biology to be different, and it causes us to produce different levels of leptin and ghrelin, all the hormones that control our hunger and satiety, different levels of GLP production. And not everyone has that. And this is what you're born with. Just like I'm I was also born with ADD. I don't know how people that have that don't have ADD think, you know what I mean? Like, I didn't know that it's not normal to have your mind wander when you're watching the news all the time, things like that, you know?

SPEAKER_03 1:29:31

Yeah. Obesity is. 40 to 70 percent heritable, which is comparable to height. So we don't look at tall people and say, just will yourself shorter.

SPEAKER_00 1:29:43

No, it's crazy. I mean, but people think that it's a good point, but people think that, oh, they look at like I've had, oh my gosh, I've had patients that have come in and they're they're um they they tell me that I brought my daughter to the pediatrician and my daughter is overweight and and the patient and the mother is overweight, and she's like, I've had pediatricians look at me and shame me because I've taught my daughter all the bad habits. I can't eat it. And it's like, well, okay, maybe you do, maybe there are some bad habits going on, but also why are there bad habits? Why in the city?

SPEAKER_02 1:30:16

Why are there bad habits?

SPEAKER_00 1:30:17

Why exactly? Why in my family did we never keep ice cream in the free in the refrigerator? Because we knew if there was ice cream in the fridger, it was like we were on attack mode there, right? Yeah, but I'd go over my friend's house after high school and she always had ice cream and ice cream cones, and I'd be like thinking all day, oh, I'm gonna eat that ice cream cone. And she's not thinking about that. And they always had ice cream in their house, but they were all thin. Have you ever heard of Petty Pals, the Petty Pals?

SPEAKER_02 1:30:39

So they're um, which I don't love the name because reasons, um, but but they're pediatricians and they're besties, and one of them has obesity and the other one does not, but they have a daughter with obesity. Right. And so they came on the show a couple years ago, and she's like, We do the same thing, and one is this size and one is the next. They got this just genetic lottery, and and then specifically talked about how difficult that was when they would go to and to have this discussion, right, with these other doctors, right? Um, for their kiddos. And I know, Amanda, do you want to share your experience with that pediatrician? You don't have to.

SPEAKER_03 1:31:13

Oh, oh well, my my son being on the medication.

SPEAKER_02 1:31:17

Well, no, like you mentioned when you went, you actually guided the doctor for better language.

SPEAKER_03 1:31:22

Oh, yeah, absolutely. Um, we actually have the same family doctor. Oh, wow. And um, I love her, I love her so much, but it is true. I I have twins, they're both 14. And um, when I brought them in, the doctor was doing their annual physical. And at this point, I'd been on a GLP one for over a year. I'd learned a lot about the science of obesity and um how to advocate for myself and other people. And so when she told my children that they needed to eat less and move more and did not talk to them about their BMI being overweight, having obesity, how it's a disease, how it's not their fault. She didn't offer to test them to see if they had insulin resistance, nothing. Just eat less and move more. And um, I was like, I would really appreciate if we could get my children lab work. I think that that's a first step that we really need because um I haven't heard them diagnosed with obesity, but I know that they are and they come from a family of type two diabetics, both of my parents, my brother. I was borderline pre-diabetic before I am very thankful I was able to get on a GLP1 medication and prevent that from happening. But um, I can see my children struggling, and I know that there's more to it. So she did actually put in the lab work orders, but she wasn't going to.

SPEAKER_02 1:32:54

No.

unknown 1:32:54

No.

SPEAKER_02 1:32:55

Like, yeah, because that's not best practice, and also because insurance and and because they don't have time with you, and all of these other reasons. But at the end of the day, the amount of people that have obesity, I don't even, I need to figure out what the statistics are. I bet you that they're that the amount of people that have hyper high blood pressure, which they do treat, and they do treat like if you think about it a lot of times in multiple ways. Like my husband has high blood pressure since he was in his 20s, runs in his family. He has to be on several different high blood pressure medications and he's skinny right now. And he was skinny then to be able to treat it because it's complicated. And I think that that they don't have time for complications, but they had did learn with high blood pressure because so many people had it, right? Well, now if we're talking about general care, it would be wonderful if we could have everybody go to experts, but that's not gonna happen. So at some point, our PCPs have got to come up to snuff like with this. And you know, I don't know how that's gonna happen. Uh, I don't know. I'm gonna be a part of it somehow. I I've just decided, but like to understand like what we need, right? And they'll they'll understand, we want them to understand the complexities of the disease, right? But that's hard to do because of the way that the system is, just like you talked about in the beginning with working for that company, right? Where you were like bump, bump, bump, bump, back to back and you couldn't provide the quality care that you need. And the thing is, is in terms of like everyone, but for sure, but definitely for people with obesity, like we deserve it. We deserve quality care like that, right? And and and people to talk to us kindly and you know, and tell us what things are and and help us understand, you know? Um, because it's gonna be really difficult. Yeah, it's gonna be really difficult to heal if nobody tries, you know. So I just love that you're doing what you're doing. I think it's wonderful that you're spending the time with them and talking with them about this. Um, and I would definitely love for you to come uh to be in Cozy Butter and talk with our community there because we have everybody in different phases of the journey. Um, people starting over, people um that have uh autoimmune diseases, um, people that are in midlife. Um, like it's it's it's you could really touch a lot of people and help a lot of people. And we would love that. I had one more question before we before we wrapped up. Um, and it's a it's a bit of a doozy, but I feel like now that we know each other, you're gonna give me things. All right. Um, here we go. All right. So what is happening in GLP1 care today that we may eventually look back on and wonder why it was even allowed.

SPEAKER_00 1:35:15

The fact that it's not that it's not being made accessible to everyone, that's the crime. You know, I I saw, I I thought about I think about that, you know, there's so many examples of things in medicine today that I'm like, how are we ever gonna look back on chemotherapy? You know what I mean? On, you know, like we're not in the future. Like I watched this funny, this this show on Cinemax called The Nick, and it was like a hundred years ago when we didn't understand blood typing and we would try to transfuse people and they would die because you know, because we didn't do that. And like C-sections were like just something people were starting, and it was like it's very medically factually adequate, accurate, accurate. And like the GLPs are something that I feel like what are we doing wrong? I mean, the oversight is definitely wrong that we're not having oversight. I think the I think the majority of providers that are giving them have they don't have adequate education around how to how to actually health healthily give them and safely give them. That's the problem. They're being made too available to like women, to people without any, without the proper guidance. Like, this is a serious drug, you know what I mean? It's not yes, it is it has complications more than aspirin, you know what I mean?

SPEAKER_02 1:36:25

That's why it's not a weight loss drug. It is a very serious drug for drug for very serious, complicated drug.

SPEAKER_00 1:36:31

Like I've seen people, I have seen complications. I've seen I had a patient that was that had been on it before and had actually had a bowel obstruction, you know what I mean? She just wasn't given the proper guidance about, you know, like for instance when to restart after a colonoscopy and things like that. But um, but yeah, people need to the drugs are so the drugs are so good and they they we keep finding more and more things good about them than bad things, and they've been around for over 21 years, you know. So it's like it's hard to find a reason to not use one. And the and the benefits keep popping up, and I think that's why people feel so free to just prescribe them without having the the knowledge and without giving the patients the education. But really, I think that's I think that's the main thing now that like, you know, they're just being allowed that we have like, I mean, there is free reign. Like every time Dick and Harry is giving these out without any kind of thought about how to keep people patients healthy on this medication.

SPEAKER_02 1:37:28

Yes. Yeah, I agree. I think that I think it's that, and I think that we'll see. Um, there was likely not a care, like an oversight with eating disorders. I think that a lot of people with obesity have an eating disorder because it developed and they need care there and that doesn't really exist or at least exist for the masses. Um, and I think all those things you said, like it's it's just it's so easy to prescribe it because we have so much data on how much it helps. But for sure, like even with the fat liberation movement, like the way they see it is they're like, it's an exphener me, we don't trust it. Like we're all gonna have heart disease and stuff. I mean that's not what the data shows, but I still understand, right?

SPEAKER_00 1:38:05

That's what like people are are getting it through telemedicine companies, and the telemedicine companies aren't even asking what their BMI is, they're not, they don't even know. So, you know, I definitely know I know people that are getting it. They're they're already probably borderline underweight, but have severe body dysmorphia and an underlying eating disorder and are are and are on it and they are losing bone, they're losing muscle, and they're gonna suffer long term when they're in their 70s and 80s and they have osteoporosis, and you know, um, and like the the weight loss made that worse. That this is a problem. It has to be under the care of a physician that knows the patient.

unknown 1:38:45

Yeah.

SPEAKER_03 1:38:46

I do want to say something. So the word eating disorder has come up several times throughout our conversation. Um, and as far as as measuring BMI through telehealth, I know there are a lot of bad actors out there. And I have reviewed probably 50 telehealth clinics. Everyone that I've reviewed does capture that information. They follow a very similar process where they take all of your information, what medications you're on. Um, I don't think that they're all, you know, fabulous telehealth clinics. Sure, no. But I have always seen them collect weight. Um, now just because I've checked out 50 different clinics does not mean I have seen all of them. I mean, I've heard of people selling peptides and GLP1 medications with their coffee from a cafe with their muffins. So I know it's coming from all over the place, and I have not reviewed all of them. Um, but another thing is that there are a lot of different types of eating disorders.

unknown 1:39:46

Yes.

SPEAKER_03 1:39:46

I had bulimia before I started, and I say had as in past tense, because it wasn't until I got on this medication that I was like, holy crap, am I cured? Did I even have an eating disorder? I feel so under control. I can live my life. I'm not obsessing, I'm not filled with shame. And I have talked to so many people who have had that same experience. And I feel like these medications get a bad rap because there are some situations where people who do not need them, especially like when it comes to celebrities who are already thin, are taking them and getting way too thin, or there are occasions where someone took it and they probably shouldn't, and they have an eating disorder that's the other way, right? Anorexia, they're starving themselves. Yeah. But I think that there's a lot of room for us to learn about how it can actually help people with eating disorders. And so I just want to make sure that that perspective is being added. Yeah. I think it's great.

SPEAKER_02 1:40:49

Yeah, no, I think it's great because um Kat and I both had um uh binge eating disorder. I say had because I don't I do sometimes have the like I want to do it, but I actually can't because I get satisfied and I'm fine. But I and I that behavior still exists and it definitely exists a lot in people because it's driven by the disease, right? A lot, right? And um and when the disease is treated, then it's kind of like, well, what do I do with myself? Right? Like that piece of it, you know, or did I ever have it? I've had that with many things, like did was that actually a thing, or was it all driven by this? I don't think we know the answer, but I think that it's it we've seen that with many people like bulimia or restriction or over-exercising, lots of different things that that go because they're just trying so desperately, right, to be able to, you know, meet what everybody says they need to meet because clearly they're doing it wrong and clearly they are fad and lazy and all the things, right? And it causes these behaviors and the behaviors are still there, but then the noise turns off, and that piece of it can be like I always say it's like really powerful, right? But it's also really scary because it's like, what are you doing now? Right.

SPEAKER_00 1:41:56

I have like a big opinion about all this. Like this is like Do you want to tell us? Yeah, okay. Yeah, oh yeah. I I I I actually tell patients that I think that like anorexia and bulimia are literally just they're on the same spectrum as being obese, right?

SPEAKER_04 1:42:12

It's just so we think too. Yeah.

SPEAKER_00 1:42:14

And the people that don't suffer from the disorder don't think about food at all. But people that have that suffer from bulimia and anorexia, they think about food all the time. All the time, all the time. Just like people who and they just treat it in a different way. And then the opposite end of the spectrum is like people that think about food all the time and then engage in the eating behavior, right? So I have definitely um, I have seen it and I've told people that like I'm not afraid to prescribe you the GLP, even with your history of anorexia or bulimia, because I've had so many patients actually be helped by those medications and they feel they are so much freer to eat, not losing, not losing, not even losing weight or not feeling like they need to lose weight, but it it again, it just frees their mind. And they've told me, like, I feel like I can just eat more intuitively. I'm not constantly having to watch every little thing. And it just, it's like it can be a miracle cure for them.

SPEAKER_02 1:43:02

Yeah. Absolutely. We've met many, many people that are that way. So I do think that is true. They get this like bad rap for that, right? And I think it's more about the disorder eating came from something, right? The behavior is likely still there and needs to be adjusted, right? Because the behavior was in reaction to, right? And I think that you're right. I think it's like a spectrum. I do. Yeah. Like I've been interviewing you guys, like that's the thing that that's what's interesting about interviewing doctors that know about this stuff. You start to be able to see the gaps and you start to be able to see the opportunities and you start to be able to see like the through line, right? And that through line has really come through in these interviews about how it does seem like it's a spectrum.

SPEAKER_00 1:43:42

Right. And the one last thing that I wanted to just mention, because um, we talked before about like what where this where GLP is and the weight, the weight management comes in as a specific problem for women in midlife, is that when your estrogen levels drop, and I deal with this all the time, almost every nine out of 10 patients come in here saying like they've they've had weight gain, weight or body change, right? So that's a weight gain in perimenopause and it's more, you know, fat distribution in the belly when they've never had that before. And a lot of that happens when you're, you know, we used to just tell people, okay, your metabolism's slowing down. This is age, but we know that when you lose your estrogen, your insulin resistance increases. You know, this is your this is your body's ability for like the insulin to work at its receptors and really take in that glucose and metabolize that glucose into energy. And so, you know, the it's why like with before we had GLPs, we had metformin, and that worked really well on um, you know, perimenopause women's. But now GLPs, like, you know, even if you can't see it on a hemoglobin A1C, you can measure fasting insulin and you can see changes, like it used to be low, now it's creeping up higher. Now you've actually reached the level of insulin resistance, but not pre-diabetes. But this is really this is really like making it very difficult for women in perimenopause to lose weight than when they've always been able to lose it before. And so, you know, that's why um I think GLPs can be like a perfect adjunct. You know, I I always like jokingly, but I'm not really joking, say like the perfect menopause cocktail is um hormone therapy and GLPs, you know. Yeah, no, I think a lot of us would agree. Yeah, they feel they feel phenomenal. And why should you not feel that way? Um, you know, what when you can?

SPEAKER_02 1:45:21

Totally. Yeah. I mean, I think it's all been it that there's I don't I can't think of any other medicine, at least. I mean, I don't know, I'm I'm 47, but that it's been so life-changing that people have podcasts and communities and you know, are evangelizing and on lives and trying to like it, it's just like a revolution. Making petitions, making petitions, which Amanda has done, yes, to be able to get this for like affordable access. And you know, I think like that's one thing I will I want to make sure I leave with our our our community and our listeners and watchers, um, viewers today is that like lifting your voice is really important. Um, and the things that we have done um to where you can and if that advocacy does not have to look like it, like how Amanda and I were all up here doing all these things. It can be just moving the content of the people that are, right? It can be talking to your family and your friends about the things that you learn here, right? Just trying to see if you can help them better understand if you think that they're in a place to receive, right? That's always where you got to get. Don't waste your time, you know. But I think there's that. And I think it's also when you go to your doctor asking for the care that you deserve, right? And if they can't provide it to you, then they should refer you to somebody that can help you. They should refer if they can't, exactly. And if they will not, then good news, you can come to the podcast, you can come to the community, and you can get all that information there to to that you can use to at least have the things that you need outside of the appointments, you know, because like that, I don't know how else to solve it other than to at least make sure that it's in a place where you could get it, you know. So that's what we love our doctors for for giving us things.

SPEAKER_00 1:46:55

Thank you for providing the platform. It's amazing.

SPEAKER_02 1:46:57

Yeah, absolutely. We we thank you for coming on and and we're excited to butter and helping us learn more. This was very enlightening, and I appreciate it, and I know my community will too, because we've been hearing it everywhere and we want to figure out like what validity is there. And so I think you've helped us decipher that, you know. Thank you so much. Thank you, Dr. Ainoin. Where can people find you outside of Cozy Butter? Where can people find you? What is your practice and um your socials, anywhere they can find you and learn more?

SPEAKER_00 1:47:23

I practice in person in Brynmarr, Pennsylvania. We're a little suburb outside of Philadelphia. I have I do telemed some for some out of state, not every out of state. Um, I do give out menopause and weight loss information on my Instagram every day or I try to every day. My handle is just Kim Einhorn, so K-I-M-E-I-N-H-O-R-N-M-D on Instagram, Kim Einhorn on Facebook, Kim Einhorn M D, I think on TikTok. And um, and my practice is called the M P Collective. And if you want information about my practice, it's the MPcollective.com.

SPEAKER_02 1:47:56

Awesome. And I have all that information and it will be in these show notes. So you can go down there and click on the links easily and go where you need to go. Okay. And thank you guys so much. Uh, we will see you next week. Asta La Pasta. Most GLP1 providers write your script and then wave you off and say, just diet and exercise. And if you're lucky, you'll actually get someone that'll help you understand how to manage your side effects. If you listen to this podcast regularly, you know that as an obesity care advocate, I believe that this journey is really complex and that you deserve better than just a weight loss program. Bell is different because they care both about community and the patient experience. They sponsor this podcast and they even brought me on as a strategic partner. I'm a Bell patient too. And if you use Bell as your provider, I can actually be part of your journey because I run a weekly patient support group hosted in their community. This is the kind of care that I want for you, and I'd love to see you there. Go to link.joinbell.com slash podcast and use code podcast at checkout to save. I hope to see you there. Give me one minute of your time. After three years of interviewing obesity medicine experts and hearing from tens of thousands of you, I still see the same gap in support between getting your prescription and then actually getting whatever you need to achieve whatever your goal is. Amanda and I are both tired of it. So we decided to fix it ourselves. Inside Cozy Butter, we have live support groups, health coaches, expert QAs, cooking and movement classes, recipes, side effect resources, calculators for your protein, your water, your fiber, even a protein meal builder, medication comparisons. So you can look at the ones now and ones in the future, all with trusted cited sources. And beyond all of that, we're creating a space for you to build real authentic connection. GOP1s are amazing treatments, but they're not cures. So we're going to need to support each other for years to come. You can join us for free today at cozybutter.com. You deserve better. You deserve butter. Welcome to the butterway. Are you interested in understanding GOP1 medications like Osimpic, Wokovi, or Minjaro? Then join us on the Plus Side, cracking the Obesity Code, the groundbreaking podcast helping people change their lives one episode at a time. The Plus Sides podcast is a disruptor. We're breaking down barriers, smashing stereotypes, and sharing inspiring stories that'll leave you feeling informed and empowered. Join us every week to learn from doctors who are specialists around GLP1 medications, like Ozinfit, Bogovia, and Manjaro. They'll provide you with science and facts to validate these incredible stories. But that's not all. We'll also bring you the voices of the GLP1 Manjaro TikTok community. Real people who face the challenges of obesity-related diseases and disorders and discover the incredible plus sides of GLP1 medications. Our episodes are filled with heartwarming stories, laughter, and moments of triumph. You'll connect with our amazing community members who are reclaiming their health and experiencing their fullest lives. Are you ready to embark on a journey of discovery and empowerment? Tune in to the plus sides, cracking the obesity code, and together we'll change the narrative around obesity and in the stigma. Subscribe now on YouTube or your favorite podcast platform and join our incredible community. Let's celebrate the plus sides of life together because every story deserves to be heard. Every life deserves to shine, and everyone deserves access to expert knowledge and medication. The Plus Sides Podcast, you're not alone. It's not your fault.