Semaglutide Without the Side Effects? Meet the Microdosing Breakthrough!

What if you could finally lose weight—without the nausea, fatigue, and misery of standard Ozempic or Wegovy doses?

Dive into this eye-opening episode of The Partovi Effect as Dr. Ryan Partovi, JD, NMD, MIFHI, and Mrs. Madi Partovi reveal the groundbreaking world of sublingual semaglutide microdosing, and why it might be the missing piece for sustainable, side-effect-free weight loss and metabolic health.

• Discover why conventional GLP-1 agonist dosing is causing so much suffering—and how microdosing offers a gentler, personalized alternative
• Learn how sublingual delivery (under the tongue) dramatically increases absorption and reduces side effects
• Explore real patient stories: from rapid weight loss horror stories to gentle, steady progress with microdosing
• Get expert insights on off-label uses for inflammation, cognitive health, and even mold toxicity
• Find out how to access safe, doctor-guided microdosing and avoid sketchy online scams

Have you tried Ozempic or Wegovy and struggled with side effects? Are you curious about a smarter, safer way to boost your metabolism and health? Join the conversation and share your story below!

We love hearing from you! Do you have questions or want to suggest a future podcast topic? Email us today at office@drpartovi.com — your input helps us create content that serves you best.

Ready to take charge of your family’s health? Visit aspenwellness.com to access personalized wellness solutions, expert guidance, and a community that supports informed, empowered health choices.

The contents of this podcast are for educational purposes only and do not constitute medical advice. Talk to your medical professional before starting any new treatment.

Don’t forget to subscribe for more enriching discussions, and leave a review if you loved the episode!

Transcript

Partovi New 

[00:00:00] 

Introduction to the Partovi Effect

Mrs. Madi Partovi: Hello, welcome back to the Partovi Effect. My name is Mrs. Madi Partovi. 

Dr. Ryan Partovi, JD,NMD,MIFHI: And I'm Dr. Ryan Partovi. 

Mrs. Madi Partovi: Ooh, and I'll be completely honest, this episode is about semaglutide and I never thought that I'd be sitting here, talking about

semaglutide ozempic. It's been a mental journey for me to, and I get questions all the time, like, why are you guys why are you guys doing this? Why are you guys heading into the world of GLP ones? And I have a, I have an answer for you because I cannot sit aside while conventional and Rockefeller medicine and big pharma continues to push drugs that are marketed [00:01:00] as the magic pill that's gonna solve everything, that's gonna make everything okay, that's gonna make drop the weight really quickly without any side effects.

Okay? I, and I promise that only a very short, a section of this episode will be like a Black Mirror episode. Okay. 

The Journey with Semaglutide

Mrs. Madi Partovi: Because I, in, in doing the research and hearing from a lot of women about this I'm so dizzy, what can I do? I drink plenty of water, so I know that's not it. I can hardly stand up or even just walk very far without fainting.

Help anyone have bad anxiety after talk after taking sema? If so, how long did it last?

Holy moly. I increased my dose of my wegovy on Monday night, and today I had the worst diarrhea of my life and I [00:02:00] feel dehydrated. I've been drinking so much all day, and I still just feel really yucky. I couldn't eat at all until dinner when I had some chicken noodle soup, and right after I was done eating it, the diarrhea came back.

This is miserable. Whew. Question for the mind hive. Is anyone else constantly cold? I've always run hot and even more so after menopause, but now I'm constantly freezing.

Has anyone went from months of constipation to suddenly having diarrhea? I wasn't sure if it's a normal change, like is this just dystopian stuff or what? Okay.

Dr. Ryan Partovi, JD,NMD,MIFHI: To me it seems pretty straightforward, but from the clinician's perspective, it's like, oh yeah. 

Mrs. Madi Partovi: Okay. There's more.

Dr. Ryan Partovi, JD,NMD,MIFHI: You're taking a medication that totally rewires your gut, so, 

Mrs. Madi Partovi: okay. So another one if you and 

Dr. Ryan Partovi, JD,NMD,MIFHI: not only that, but you're taking a massive dose of it. 

Mrs. Madi Partovi: Okay. If you have a lot to lose, I'm talking 85 [00:03:00] pounds and are just starting, is it okay if you don't eat quite enough? This is literally day two. Most of this e even felt forced.

It seems like quite a bit of food too. I normally eat, I'm a binge eater, smashing 3.5 to 5K calories a day. 

Dr. Ryan Partovi, JD,NMD,MIFHI: I didn't really get what was different about them being on the semaglutide, though? They're normally a binge eater, but then they find on the semaglutide that they're what, 

Mrs. Madi Partovi: I guess not. Like, not eating.

Dr. Ryan Partovi, JD,NMD,MIFHI: Not eating. Yeah. 

Mrs. Madi Partovi: That's, 

Dr. Ryan Partovi, JD,NMD,MIFHI: yeah. 

Patient Experiences and Side Effects

Mrs. Madi Partovi: My fatigue is awful. I have zero motivation and I'm tired 24 7. So I'm two and a half weeks in. So the, this is the the conventional macro dosing injection protocol. Okay. Yeah. Of these various drugs. So I am two and a half weeks in the first week, and I did not want any food. But I did my make myself eat and now I'm, all I'm thinking about is food. Is this [00:04:00] normal?

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. If you're a nutrient and calorie deprived, I'm sure it is normal. 

Mrs. Madi Partovi: Yeah. And then this I haven't seen below one 90 in several years and it made me tear up seeing it this morning. I don't know what I'm gonna do once my insurance stops covering in July, the whole insurance game. Week seven here, I lost 20 pounds and my struggle on shot day and two days after I want to eat nothing.

I have to force myself to eat one meal and I don't sleep well at night, the night after a shot, and about two to three nights after.

Whew. 

Dr. Ryan Partovi, JD,NMD,MIFHI: You got a lot of these, don't you? Yeah, 

Mrs. Madi Partovi: I'm on day four. I'm at seven units and not hungry at all. I find eating a chore and really don't want to, I don't want to eat. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Fundamentally what this medication does is [00:05:00] medically induced fasting, right? 

Mrs. Madi Partovi: Okay. Here's one.

Dr. Ryan Partovi, JD,NMD,MIFHI: Okay. 

Mrs. Madi Partovi: Yeah. Three months in. Why am I craving sugar again and having food noise? I see a lot of those. 

Dr. Ryan Partovi, JD,NMD,MIFHI: What's food noise? 

Mrs. Madi Partovi: I wanna eat. I wanna eat. I'm so hungry. Oh my God. I'm thinking about my next meal. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Maybe that's called starvation. It's called a starvation response. The people who fast, they talk about how if you fast long enough, eventually you truly start to have hunger pangs, which is like, it's painful to be hungry, and that's when you know you need to break your fast.

Mrs. Madi Partovi: What are y'all eating in a day? I feel like some days I'm just not hungry and I struggle with migraines and already have thin hair, so I know I need to get my protein in. 

Dr. Ryan Partovi, JD,NMD,MIFHI: You think? 

Mrs. Madi Partovi: You think? Yeah. I'm struggling to eat even a thousand calories a day. I'm only able to get around a hundred grams or so of protein daily on average.

Struggling to eat 

Dr. Ryan Partovi, JD,NMD,MIFHI: how [00:06:00] many grams of protein? 

Mrs. Madi Partovi: A hundred.

Dr. Ryan Partovi, JD,NMD,MIFHI: Depending on what their weight is, that may be okay. It's hard to say. 

Mrs. Madi Partovi: Yeah. My, my point is that what people would do, what people would endure because this has been mass marketed. 

Dr. Ryan Partovi, JD,NMD,MIFHI: I'm smiling because 

Mrs. Madi Partovi: no, another one 

Dr. Ryan Partovi, JD,NMD,MIFHI: I'm remembering all of like the body positivity people.

I'm like, you effing liars, right? Like you effing con men and women, like for anybody who believed the body positivity movement for half a second, right? Like, no, humans are just as concerned about looking good as ever. This just in, 

Mrs. Madi Partovi: well, at the cost of the fundamental health. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Oh. Sure.

Mrs. Madi Partovi: The mental health, emotional health. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah.

[00:07:00] Yeah. 

Conventional vs. Microdosing Approaches

Dr. Ryan Partovi, JD,NMD,MIFHI: Because fundamentally what's going on, and this is, I really, just to respond to what you said at the beginning of the episode, I never wanted to do Ozempic episode because to me this is a treatment that's like a second or third line treatment for type two diabetes.

Sometimes it can help reduce the amount of insulin needed for a type one diabetic or insulin dependent diabetic. But, that's how I've always used these medications in practice, which is to say not very often because usually we u do a combination of nutritional lifestyle changes, nutraceuticals, botanicals, and.

Maybe metformin, maybe a carbo. But that's usually the only medications that, a diabetic patient under MyCare might ever be on. I think I prescribed the GLP one. Let's just put it this way. I could probably count the total number of times on one hand in 15 years of practice.

So, given [00:08:00] that I didn't think we would really need to do one because I feel like there's plenty of other episodes that are, people have done great episodes on, but then we had this whole, microdosing phenomenon come up. And I think that's what really, and that was in many ways, I think started by my colleague Dr.

Tina Moore. So I want to give her full faith and credit on that concept. But I would say that there's been some good debates and some good conversations. I know she had a good one with Dr. Mark Hyman and Kelly means, and I'm sure there's other ones, but 

Mrs. Madi Partovi: before you go on, 

Dr. Ryan Partovi, JD,NMD,MIFHI: before I go on, sorry, let's a 

Mrs. Madi Partovi: couple more.

Dr. Ryan Partovi, JD,NMD,MIFHI: Oh more. Okay. Just 

Mrs. Madi Partovi: a couple more.

So I'm having cravings and I'm giving into them. I can't do this. I cannot gain my weight back. But I know we're supposed to try to do the lowest dose possible. Okay. And then the last one, constipation [00:09:00] help. So this sounds for me like very similar to what I went through during the COVID days, where we could not with integrity, sit on the sidelines and not jump into the game and provide something that was effective for the people. Okay. With very minimal side effects. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. I see what you're saying.

It's like the idea of,

That mid where is the middle ground, I think that's what you're pointing to. 

Mrs. Madi Partovi: Absolutely. 

Dr. Ryan Partovi, JD,NMD,MIFHI: You're like, okay, there, this is what conventional medicine is saying. There's plenty of people on the opposite end of the spectrum saying, oh, it's the worst thing ever. Avoid it like the plague.

And just like during COVID when people were saying, oh, you just need herbs and vitamins to treat COVID. And other people were saying, no, you need paxlovid or you need to get the [00:10:00] vaccine, or that kinda thing. We were like in this excluded middle of Ivermectin hydroxychloroquine, calcitriol, et cetera. So, 

Mrs. Madi Partovi: so you can bet that, I was leery and you were like double, triple leery, yeah. About for sure. Ozempic, when it first came out for this for weight loss, and then when it was handed out like candy and it's still being handed out like candy, without you can go through online companies.

I've looked at some of those websites, like glamor peptides, just really shady stuff, that people are willing to, because they, I don't think the people have like, full informed consent about all this. They have to resort to, like, going into Facebook groups for support, because they don't have a doctor that's guiding them through this process.

They have doctors that are willing to just, oh, here I'll prescribe you medication. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

Mrs. Madi Partovi: And that's it. 

Dr. Ryan Partovi, JD,NMD,MIFHI: That's why, that's why now they want to call us healthcare [00:11:00] providers 'cause we're providing healthcare. But it's like, here's your prescription. It's more like electronic, right?

It's still, it's like we're here to provide you with the treatment, not to practice medicine anymore. Which is to me an anathema to the way that, that we think and practice. But. 

Mrs. Madi Partovi: So do you get my why? Like, does that really land? Like if I had my best friend, like sitting across from me actually did the other day, like, why did you guys get into this game?

That, that is the reason it isn't a response to the irresponsible, substandard care, that's persisting out there. Okay. That's hurting people. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. No, I totally get that. We deal with that same thing on the integrative oncology front. We see that a lot of the tools of oncology get wielded almost like a, a giant [00:12:00] mallet as opposed to a scalpel, which is the goal, right?

You want precision, you want a robot guided scalpel. You don't want someone coming at your cancer with a, a giant mallet. But the thing is that a lot of the treatments end up being more like that, as chemotherapy often gets described, it's like trying to use a nuke to kill an ant. So, yeah, I think in many ways the way that semaglutide in the other GLP one agonists are being prescribed and utilized by many people is analogous to that.

It's more of like, it's more of the chemotherapy version versus like the sharp robotic guided scalpel version. 

Mrs. Madi Partovi: And, fundamentally what we are about what Aspen Wellness Institute is about is not a one size fits all approach. It is customized and tailored the person.

And also, I read a couple of the the examples of [00:13:00] people saying that I'm giving into cravings again, it, it's happening again. All the food noise is coming back. What do you think if you have not dealt fundamentally with the mental and emotional response, like your relationship, your fundamental relationship with food?

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. That's one of the problems with with the conventional model in general is that it's like here is this very laser that's the wrong word, but I would say there's this very we're gonna focus on this one molecular mechanism and we're gonna put a treatment that just targets that one molecular mechanism.

And it's almost like. Reductio ad absurdum writ large on a biological level, it's like we're gonna, we're gonna reduce our intervention to one particular molecular mechanism and ignore the, not just the whole body, but like the whole environment and past that people are bringing [00:14:00] into the present and the even into their future.

And all of the ways in which those things are giving them who they are in the present, are giving them their health, their way of being, their way of acting and,

Mrs. Madi Partovi: somehow their, 

Dr. Ryan Partovi, JD,NMD,MIFHI: Their wellbeing. 

Mrs. Madi Partovi: Yes. So how are we going to enter into this game honorably, and keep sacred, like the individual?

Dr. Ryan Partovi, JD,NMD,MIFHI: I think we're not playing a game. That's the whole point. I'm like, no, I'm not interested in playing a game. Certainly not with patients' health or lives. And I think that that being said, like, one of my professors Mahe, rest in peace. Dr. Jim EG. Was an old school naturopath who used to say, you're not a real naturopathic physician until you've been in jail at least once on behalf of the profession.

He was that old school. But yeah, he would say, look, there's no such thing as a good and bad drug. There's only good and [00:15:00] bad doses and good and bad uses. So that really begs the question of like, okay, so there's this medication. What are the, what's the proper dose? What's the proper way of prescribing it?

And 

Mrs. Madi Partovi: yes.

Dr. Ryan Partovi, JD,NMD,MIFHI: That's something I think we're gonna get into. 

Mrs. Madi Partovi: So in, as we began this journey, there's a lot of research that went into it and beyond like demonizing the drug, right? So at which doses could it have benefits? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Did you want to, take any of the things that you had already offered the, that you'd already read?

Did you want to take any of those One at a time? And I. Kind of go through them and address them, or did you want to just 

Mrs. Madi Partovi: jump right? No, I just I, my point is that the way that conventional medicine is doing it hurts people, and they're left dealing with all of these side effects [00:16:00] alone, like either alone or, they're trying to they're trying to navigate it, like go through it because there's some kind of prize at the end, but there's no prize.

There's, you have to be on this medication long term and unless you really deal with like the root cause of, why you're eating the way you're eating and your metabolic dysfunction, your metabolic derangement, which has probably been happening, for the past like five to 10 years at least.

At least, for you to get to this point. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. So I think what you're saying is if someone is using it just for weight loss and they're using it by itself in the absence of any other, more of a holistic approach, then you can end up with not only side effects, but I think a lot of the just negative long-term effects because you're not dealing with any of the underlying cause of the obesity to begin [00:17:00] with.

Mrs. Madi Partovi: Regression, severe muscle loss, fatigue. You can't poop. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

Mrs. Madi Partovi: You can't poop. Yeah, 

Dr. Ryan Partovi, JD,NMD,MIFHI: If you don't eat, you just wanna, if you don't eat, you're not gonna poop. So that makes sense. 

Mrs. Madi Partovi: I just wanna remind people that, the hospital rounds that you did, most of the people that came in with came into the emergency room.

Like they really just needed to go poop. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, that's true. Yeah. There, I don't know about most, but I would say in terms of GI complaints, at least eight out of 10 GI complaint that ends up in the ER are somebody who needs to go poop. And it's really, it's that bad. So, yeah, in fact, there was a doctor there who apparently is no longer there, but ended up going into holistic medicine, but she used to order a lot of enemas for her patients, which the nurses of course just loved 'cause they were the ones that had to do them.

But yeah, no, I mean it's it's wild. Where were we going with that before? 

Mrs. Madi Partovi: I'm heading towards our journey, our mental, emotional, almost like spiritual journey [00:18:00] about getting involved with this. And so we've arrived on, the benefits of Semaglutide.

Dr. Ryan Partovi, JD,NMD,MIFHI: It's Semaglutide. 

Mrs. Madi Partovi: Semaglutide, 

Dr. Ryan Partovi, JD,NMD,MIFHI: yeah. Dr. Tina Moore. I love you, but you say it wrong. She 

Mrs. Madi Partovi: says it both ways. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Really? That's funny. 

Mrs. Madi Partovi: Yes. 

Dr. Ryan Partovi, JD,NMD,MIFHI: I don't know why. Maybe she's changed, maybe you've looked at older things and she's realized, oh wait, I was saying it wrong. And she's very possible. She's could have cur, that's part of being curious and being a good physician is you're willing to, change your, but according to the manufacturer, I looked it up before this episode.

Mrs. Madi Partovi: So at what doses, at what micro doses could it be beneficial for people? And if we are also addressing lifestyle and, genotype diet, and if we're focusing also on fitness could it be, the the drop that makes the difference for you? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. I think, to me what I've come to, to see [00:19:00] it as maybe, 

Mrs. Madi Partovi: oh, I just wanna say drop because we are our program is the delivery is sublingual micro.

When you say 

Dr. Ryan Partovi, JD,NMD,MIFHI: our program what do you mean by that? You're talking about you, there's a baseline assumption there that you're making what? That our audience may have no idea what you're talking about because not everybody that's watches and listens to the podcast. Is on our newsletter, so.

Mrs. Madi Partovi: Okay. 

Introducing Metabolic Microdosing

Mrs. Madi Partovi: We've developed a new program called Metabolic Microdosing. Okay. And included in the program is sublingual microdosing of Semaglutide. It also includes addressing all the mental, emotional baggage that a person has, a person may have with food and way of eating and relationship with food.

And it also addresses fitness. It's a comprehensive program that, yeah, holistic. Yeah. Holistic. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. And I think that ultimately when you [00:20:00] look at the way that people often are around food and especially around weight loss, the most important thing is gonna be compliance and sticking with it. And we've seen that over and over again.

And so the many times, the most important thing is being able to stick with it. And that's something where I think if people have struggled with that, then the microdosing can help. I also think that if people have been doing all the right things and then they're struggling, still continue, to continue to lose weight, sometimes there's an underlying metabolic issue we haven't dealt with.

And, obviously we have our. Wellness practice where we deal with those kinds of issues. I feel like a lot of times if those get addressed, then the weight does come off. But then, occasionally you'll find someone where, whether, because I think that their metabolic set point is just not where they want their body to be, so there's like a [00:21:00] mismatch between, and I think that sometimes happens over the course of a lifetime of yo-yo dieting, where basically the metabolic setpoint will just keep getting ratcheted up and ratcheted up in terms of what the body sees its ideal weight to be.

And there's very different, it's funny, there's a lot of different ways to address that. You can address it with things like hypnotherapy and guided meditation and you can also address it with psychotherapy and you can also address it biochemically. And this is one of the biochemical ways is with the microdosing or with semaglutide.

But I think that the way that most people are doing, it's like this, it's a brute force. Whereas we're like, Hey, this is a gentle nudge with the microdosing. 

Mrs. Madi Partovi: Yeah. So, so today I'd like to take a, a dive, a deep dive into sublingual microdosing of GLP one receptor agonists, especially Semaglutide and gonna break it down for our community.[00:22:00] 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Yeah it's really a new way of using this medication that's now become pretty well known. As we've mentioned, most people know it as either Ozempic or Wegovy. And there's been lots of news articles about the use of it in both weight loss and diabetes. And typically it's given by injection.

And, with the microdosing, we're not doing injections, we're doing tiny sublingual amounts under the tongue. And we'll talk about, as we go along a little bit more about how that works and why we're frankly excited about it. Yeah. So, and we also have some questions. I don't know if you, did you want to go over the questions or you want me to?

Mrs. Madi Partovi: So some of the questions that we've received from our community does this approach work for people with mold toxicity or autoimmune illness? You wanna answer that now? 

Dr. Ryan Partovi, JD,NMD,MIFHI: No. I'm gonna [00:23:00] answer these kind of things through as we go through, but I'm just, 

Mrs. Madi Partovi: Another question. Isn't the oral bioavailability of semaglutide too low for a tiny dose to matter?

Why not just use the new drug tirzepatide like Manjaro or Zep instead and more? So we're gonna address those. And even some common criticisms. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Some things you may hear from mainstream sources and present, present all sides of the discussion as our goal here, create the new consensus.

Mrs. Madi Partovi: Can you tell 'em about that neat rat study? 

Dr. Ryan Partovi, JD,NMD,MIFHI: We will. Yeah. We're gonna get into that too. So as well as some insights from compounding pharmacists and, other physicians that are, have been involved in pioneering this approach. So, yeah, I mean I think that 

Mrs. Madi Partovi: and the intention, the overall intention is, when I was sitting across from my friend the other day we are going to put you the patient at the center [00:24:00] of this discussion and it's about exploring an option that might empower patients who couldn't tolerate the big doses or who want a more gentle, personalized path.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Or who, would never touch the stuff in the injectable form, but maybe have plateaued in their weight loss efforts and are looking for like, okay, what could help me, what would be the next step to gently move me through this plateau? Yeah. Great. So. 

Understanding GLP-1 Agonists

Dr. Ryan Partovi, JD,NMD,MIFHI: I think first of all, we have to start by talking about what is a GLP one agonist.

So, glp one is glucagon-like peptide one, which is hormone produced in the gut, especially after we eat and it regulates our metabolism. So, for example, GLP one signals to the pancreas to release insulin, helps control blood sugar, and then it also has effects on [00:25:00] the brain to reduce appetite.

So, essentially it's one of the hormones that tells you that you're full, you should stop eating and it actually slows down how fast your stomach empties, which means you end up feeling fuller and your blood sugar levels say steadier. Does that make sense? 

Mrs. Madi Partovi: Yeah. It's like the hormone that politely pushes your plate away when you've had enough.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, definitely. Exactly. Actually. So, the GLP one receptor agonist, which is what these medications are, anytime you have a hormone agonist, it's gonna be a drug that mimics a particular hormone typically. So, or neurotransmitter or something like that. So an agonist is a medication.

GLP one agonist is a medication that mimics natural GLP one. It's not the same as GLP one because if you were to take something that was the same as GLP one, [00:26:00] because it's a peptide hormone, and peptides just get digested into amino acids in our gut, it's gonna get immediately digested. So they have to modify it to resist digestion.

And so semaglutide is one of those medications. It binds to the same receptors that your natural GLP one does. And it suppresses appetite, reduces food intake, slows that gastric empty. And so you stay full longer and improves insulin secretion while reducing glucagon release. Now here's what's interesting though, is that even though it enhances insulin secretion, which is gonna in stabilize blood sugar over time, there's, 'cause my first question was what about somebody who's insulin resistant?

Isn't it just gonna raise their insulin and it's gonna make things worse? Interestingly enough, no. Over time it actually lowers fasting insulin because it's improving insulin sensitivity. It's not immediate, but it does actually do that over [00:27:00] time. It's one of the more long-term effects of it. So in practical, for practical purposes, it's making you feel less hungry.

So it helps you eat less, stick on whatever regime you're doing and then also keeps. Your blood sugar in healthy range, which is typically what I would've prescribed it for, many years. 

Mrs. Madi Partovi: So you touched on this earlier. 

Semaglutide for Diabetes and Weight Loss

Mrs. Madi Partovi: Semaglutide was originally developed for type two diabetes because of blood sugar effects, right?

Dr. Ryan Partovi, JD,NMD,MIFHI: So it started as a diabetes medication and in fact, Ozempic is the diabetes version. Wegovy is the one that they're now marketing just for weight loss. But doctors, we pretty much noticed pretty early on that patients would lose weight on it. In fact, one of the reasons, so I only prescribe for non-insulin dependent diabetics in my practice, I only prescribe medications that are either weight neutral or help patients lose weight for diabetes.

I've never prescribed a drug that increases the weight of the patient. 'cause it just doesn't make sense to me. If you have a [00:28:00] type two diabetic, you want 'em to lose weight because they're typically always at least overweight. And and you want something that either improves insulin sensitivity or again, is neutral.

And so this was useful when it came out because it was like the third class of medications that we had that actually did help people lose weight and did improve insulin sensitivity and. That ultimately led to additional trials for obesity and trying to help people lose weight. And they tested it at escalating doses.

And, ultimately that led to the version that's wegovy that's approved and that's at 2.4 milligram weekly dose, just a weekly injection the way it's typically prescribed. And, as we've seen, and I think most people have seen by now, it's been a ga game changer in weight management.

And, the whole bariatric field, frankly because people are often losing 15% or even more of their total body weight in the trials, which [00:29:00] is really unprecedented for a medication prior to this, I think the most we ever saw from a medication was like maybe 10 or 11%. So it's like, I, and those were, I think, maybe even had more side effects, ironically enough.

We're talking about things like phentermine and Orlistat and things like that which never, they didn't really work very well and they had a lot of side effects. I even more side effects I would say. And it's gotten to the point where, you know we now know these drugs, their household names, every social media celebrity news, you hear about 'em all the time.

Mrs. Madi Partovi: Yeah. I would assert that almost everybody has heard about Ozempic and they're, the marketing is strong with them. And people that we've known for years, it's a little surreal and you can just kinda like, oh, Ozempic, that have been overweight for years and then all of a sudden within like a two to three [00:30:00] month period.

Like what? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. And really unhealthy weight loss. In, in the medical world, healthy weight loss is like a pound and a half, sorry, a half a pound to a pound of really ideally fat, right? But it's hard to make sure that it's only fat, except by making sure you're getting enough protein, enough amino acids and also weightlifting or the two main ways to help make sure you're not losing too much muscle mass.

But really we look for a pound to half a pound a week. More than a pound a week is just considered way too rapid in, in everything I've ever heard or read or learned. And yet we're seeing, two pounds or sometimes even more per week on some of these medications. 

Mrs. Madi Partovi: Yeah, which means I'm seeing saggy skin.

I'm seeing just a really gaunt looking face.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah the saggy skin happens because of [00:31:00] the, there's not enough time for the body to resorb the skin. That's grown as part of the process of of gaining weight over the course of decades. The body needs time to resorb that skin.

And if it doesn't have it, if it's super rapid weight loss, you're gonna get that, whether it be through a gastric bypass or whether it be through one of these medications. Yeah. 

Mrs. Madi Partovi: And one of the main complaints with women is that it's making them look much older. 

Dr. Ryan Partovi, JD,NMD,MIFHI: And I wanted to talk about the fat in the face part too.

That's very common with fasting. People who are on super low calorie diets or do too much fasting, they will often lose facial fat. And facial fat is one of the main ways that you stay looking up, right? So one of the dangers of prolonged fasting or too much too low calorie diets which is what can happen on these super high doses of, these milligram doses of semaglutide.

You end up with a lot of, days where you're either not eating or you're [00:32:00] eating just not nearly enough. So certainly not enough protein. 

Mrs. Madi Partovi: The, so the dose is quite high with the conventional approach and the injection, the once a week injection protocols. 

The Problem with High Doses

Mrs. Madi Partovi: Could you outline what the standard dosing looks like, just to have a comparison?

Dr. Ryan Partovi, JD,NMD,MIFHI: Sure. Yeah. We're looking at, milligrams for the injection, micrograms for the sublingual. So, literally a hundred times less for the sublingual, but we'll get into that in a second. So, the standard protocol for wegovy, which is semaglutide for weight loss, is an escalation to reach this high dose of 2.4 milligrams a week.

So usually they're gonna start out at 0.25 milligrams a week for about a month, and that's, they call, that's the starter dose. And then you increase to 0.5 milligrams a week, and then one milligram, [00:33:00] 1.7, and then finally 2.4. So each time you increase, you stay on it for a few weeks to acclimate, but the goal is to try to ratchet you up to 2.4 as quickly as possible, or as close as you can get, and still tolerate it.

And the reason, the only reason why they do it. Over time is to try to reduce the nausea that a lot of people experience, if not most people experience, when we use it for diabetics, the target dose is typically maximum historically has been one milligram a week, although there's now a two milligram version that's come out.

But essentially we start with the weekly dose and titrate up. And yeah that's the approach that, it's the same approach, but I would say that, which we, with the weight loss, we get to that higher dose a lot faster because that's what's often, gonna get this dramatic result, [00:34:00] which is exciting to people.

And I get that, but it's like often unhealthy and often comes. Yeah, that's a side effects, 

Mrs. Madi Partovi: that's a huge range, from point 25 milligrams to two milligrams or more per week. Even at the starting dose that's like 50 or five to 10 times higher than the micro doses that we're gonna be offering.

Dr. Ryan Partovi, JD,NMD,MIFHI: So even at the 0.25, we will be starting people off really at like 0.05. So that's like, I think what, that's 50 micrograms. Or no, maybe even lower than that actually there's a there's a lot of flexibility 

Mrs. Madi Partovi: between five to 50. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

Mrs. Madi Partovi: Micrograms and a microdosing regimen. That's a massive, that's 

Dr. Ryan Partovi, JD,NMD,MIFHI: typically, yeah, typically where we're going is much, much lower.

Mrs. Madi Partovi: Okay. That's a massive difference in quantity. Just wanna say, 

Dr. Ryan Partovi, JD,NMD,MIFHI: yeah, we're looking at much, much higher [00:35:00] doses. And I think that's part of the problem. It's one of the reasons why people max out. It's why, they get, you get this rapid weight loss, but then now what? Are you gonna stay on it to maintain that?

Is that really sustainable? Can you afford that? So there's a lot of elements to it that frankly don't work. And I think, to me the same issue we have with Ivermectin. I have, I do ivermectin for cancer and I had a patient that just totally ignored what I told 'em to do and ratcheted up as ivermectin to like 120 milligrams a day.

And now he can't take ivermectin. He can take like 12 milligrams, but he overshot the therapeutic window, saturated his tissues, and now he can't take it. So I think the same thing happens with these medications where it's basically like your body develops a tolerance to such a high dose and then you either have to stay on that high dose or you have to, to maintain the weight loss or you start gaining weight again, okay. So the 

Mrs. Madi Partovi: moral of that story [00:36:00] is like, don't do, so many people are doing this on their own, unsupervised, no, no guidance with somebody that cares. 

Dr. Ryan Partovi, JD,NMD,MIFHI: And I think that the other thing I would say the other piece that's so important is to do the minimum effective dose.

And the effective dose is the dose at which you are losing weight and not to increase the dose unless you stop losing weight. And then to then again, use the minimum effective dose. And I think that principle is being lost in the conversation of like, oh, let's ramp everybody up, and it's a one size fits all typical approach. I. It just reminds me of the whole conversation that we've had about vaccination, where it's like, if you had truly smart vaccination, you'd be looking at everybody's genetic susceptibilities. You're looking at their mitochondrial DNA. You'd be looking at have they had the D disease [00:37:00] before?

Do we even need to vaccinate them? Maybe they already have robust immunity. Are they actually at risk from anything from getting this disease? You'd look at it holistically and then you'd maybe give them one dose of one vaccine and then see what their reaction to it was and go from there.

Instead, it's like, we have a schedule. Everybody's gotta stick to the schedule. If you're not on the schedule, you're an anti-vaxxer. It's like, not necessarily, like that's your framing and it's all in the framing. But I think that's, but that idea of like, just let's ramp it up.

It's just very typical and everybody on the same thing. It's like as if we don't have biochemical individuality, as if we don't have, people that essentially, you know, one person that may need one, 100th of the dose of someone else. And that isn't to say that people don't get some benefits. I did wanna mention one thing that I forgot to mention earlier about what kind of benefits are people getting?

Yeah. They're getting the rapid weight loss. We do know that actually getting that [00:38:00] rapid weight loss has positive effects on long-term cardiovascular disease risk. On even some cancer disease, cancer risk, losing the fat is a good thing for your long-term health. I'm not disputing that.

I don't think you would either. 

Mrs. Madi Partovi: No. 

Dr. Ryan Partovi, JD,NMD,MIFHI: It's really for us about what else are you losing along the way? Are you also losing bone and muscle and, but 

Mrs. Madi Partovi: Hey here's what I have to say about that. So there were women were posting pictures of what they were eating or trying to eat and there was a plate of, jello, processed of jello and then processed meats.

Yeah. And there were a lot of pictures like that. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. It's very sad. 

The Concept of Microdosing

Dr. Ryan Partovi, JD,NMD,MIFHI: So, but yeah, getting back to the microdosing, microdosing is basically, you want to think micrograms versus [00:39:00] milligrams. And yeah, it's just really 

Mrs. Madi Partovi: and it's there's 

Dr. Ryan Partovi, JD,NMD,MIFHI: really like two main elements to this that I think we're responding to.

And I just wanna maybe emphasize this again because, and we'll probably keep emphasizing it, but it's like the one size fits all mega dosing. Obviously doesn't work and the all you have to do is shoot yourself up with this drug and then just keep doing everything else the way you've been doing it and you'll be skinny.

And, healthy forever is obvious gaslighting, right? 

Mrs. Madi Partovi: Yeah.

Dr. Ryan Partovi, JD,NMD,MIFHI: Without changing any of your other habits, without addressing any other things holistically, it's like, no. The moment you stop that drug, you're gonna regain all the weight. And, if you stay on it at that high dose for a long period of time, there will be other negative consequences that you haven't there haven't considered.

Because just like everything in biology, there's always trade-offs, right? So, 

Mrs. Madi Partovi: What do you think is missing? Especially with the, [00:40:00] call it the looking good industry and how women that, they're willing to go through these intense side effects, this nausea and vomiting and upset stomach and not being able to have regular bowel movements.

I'm like what is missing that we could put in like, the presence of what should make the difference for people to say wait a minute, pay, Hey, industry, wait a minute, is this really something that is there something else that's available to me? 

Dr. Ryan Partovi, JD,NMD,MIFHI: And that's what, that's the answer, right?

There's gotta be another option. There's gotta be another way, there's gotta be another way. And there is. 

And I think that this is what, where we've landed on this, I think is probably the sweet spot, which is let's not throw the baby out with a bath water and say that these medications are never good or not useful at any dose, but [00:41:00] rather to find out when and where and how.

And then also combine it with, everything else that we would normally do to help people lose weight. 

Mrs. Madi Partovi: Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: So, I think that, but having that as a clear alternative I think is what's missing. You asked what was missing, I think that's that, that is what we're doing with this program.

So, and you mentioned a lot of really, the gnarly side effects. It's true that the GLP one's, most common side effects are gastrointestinal. So the nausea, vomiting, diarrhea, constipation, heartburn. And that's because most of these receptors are in the gut and the brain.

And so, when you ratchet that dose up really high, your digestion is gonna slow down a lot. And the brain is gonna basically say, oh, I'm not interested in food right now. And that can often. Result in that queasiness, that nausea feeling. And for a lot of people, [00:42:00] the side effects seem to be manageable and worth the benefit.

I will say that, there are people who do well on these mega doses and maybe they needed them, maybe they didn't. But I would say that just like with the vaccine there were people who took it and seemed to at least not have any immediate negative effects. Now, we now know from looking at SP osteopathy and looking at antis spike antibody titers, that we see that, oh wait, there were some negative effects there that maybe they weren't present to immediately because, they survived it and they didn't have like an immediate horrible reaction.

But maybe now they have vascular disease or they have, cancer or they have something else. That's, 

Mrs. Madi Partovi: yeah, I am almost banking on the fact that we're gonna see a rebound effect because these drugs have not been around for this long or being used in this manner for that long. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah.

And that's, so 

Mrs. Madi Partovi: It's all a huge experiment, that people are willing to willing to put in their bodies. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

The Benefits of Microdosing

Dr. Ryan Partovi, JD,NMD,MIFHI: And at the same time, I would say, that being said, there is an unmet need out there. I get that there [00:43:00] are people that absolutely want to and need to lose weight and have struggled with it and feel frustrated by it and don't know what to do.

Mrs. Madi Partovi: And we are here for that unmet need. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, of course. But that's where I think, I don't wanna step over that. I want to acknowledge it and at the same time, make it clear that the option that's being provided by the conventional medical establishment is a if your insurance covers it, I guess it's not unreasonable to, but even then I would say why ratchet up the dose if you're losing weight?

Just stay where you are. If you're losing you, the minimum effective dose should be the approach, but it's because, this one size fits all. That's what the study showed. Why do you think the study was designed that way? Because they wanna sell more medication, 'cause it costs more and boy, are they something to buy more?

Boy are they selling? It just seems so absurd to [00:44:00] me. But yeah, a lot of times my preference is to try to use a medication that's been around for 35 plus years because we really know, we know everything about a medication or as much as we can. In the naturopathic world, we're using a lot of like basic dietary interventions, botanicals that have literally been around for thousands of years.

The effects are very well known with medications. We consider a 30 to 35 year range to be acceptable in terms of, of, of what we know about the medication. But, the newer drugs, I think to me caution is indicated. So precautionary principle says, again, use the lowest effective dose for a medication that we're not really sure what all the downstream effects are gonna be yet.

Mrs. Madi Partovi: Yeah. So here's where we're gonna set the stage. Okay. Okay. There's efficacy at high doses, but stupid side effects. Okay. So the twist of today's episode is microdosing. Semaglutide. We're gonna take a a deep dive [00:45:00] particularly via the sublingual method. Yeah. Okay. So what do you mean by microdosing?

Dr. Ryan Partovi, JD,NMD,MIFHI: As we've hinted at microdosing means using the significantly smaller doses than the standard protocol. And the goal is to really harness the. Same benefits of the drug while minimizing really focusing on minimizing the side effects and, the trade-offs, if you will.

And so we're literally talking about fractions of the usual dose, sometimes an order of magnitude or too lower. Which, for those who don't remember that part of their algebra, it's anywhere from 10 to a hundred times less than the standard dose. So instead of, 0.5 to two milligrams per week, a micro doer might use tens of micrograms in, in throughout that week.

And so, as one of my colleagues describes it, it's a significantly lower dose than [00:46:00] what's prescribed fractions of the standard dose. 

Mrs. Madi Partovi: Okay. It's like using a whisper instead of a shout. Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: It's a nudge, versus a mallet over the head, and I think the goal here really is to see if we can get some clinically meaningful effects from that whisper of semaglutide.

And that's really what. My colleagues and I have been seeing is you get the better appetite, control improved metabolic markers, anti-inflammatory effects without that shout of the side effects that often comes with full doses. 

Exploring Off-Label Uses

Dr. Ryan Partovi, JD,NMD,MIFHI: So microdosing obviously is off-label. Our old friend, the old off-label repurposed, so, this is not obviously an FDA approved regimen.

It is an FDA approved drug. So this is a, you, it's a newer experimental investigational, if you will, a strategy. And of course the manufacturer, of course does [00:47:00] not endorse microdosing. And that's because, and they'll say, oh, it's because we don't have large studies proving it's efficacy.

But, the reports are, and we've certainly started to see that that those of us who are exploring this kind of approach, I would say the more forward thinking clinicians and patients often, because they've run out of options or because they're just curious to try it, are starting to see some clinically meaningful benefits.

And I think that makes a lot of sense. 

Forward-Thinking Approaches in Medicine

Mrs. Madi Partovi: Yeah, I think this is in the realm of, the clinicians and the

practitioners who are forward thinking. And if there's anybody that I know who is forward thinking and patient centered it's so that, 

Dr. Ryan Partovi, JD,NMD,MIFHI: thank you.

Yeah. And the reality of the matter is that some patients just can't tolerate those full doses. [00:48:00] 

Mrs. Madi Partovi: Yeah. 

Reflecting on COVID-19 and Ivermectin

Mrs. Madi Partovi: I was just, I was gonna say that I brought back to like the COVID days, when I did mention I ivermectin to you and that I said, Hey we have to do something, and when I brought this up initially you did not, you said you didn't wanna touch this with a 10 foot pole.

I 

Dr. Ryan Partovi, JD,NMD,MIFHI: did say that, yes. 

Mrs. Madi Partovi: Okay. So there was a lot of that only research that you did, but that forward thinking, that has, you like, put yourself on the line for people. 

Dr. Ryan Partovi, JD,NMD,MIFHI: It reminds me what RFK JR says, which is like, look, I am amenable to sufficient evidence. If there's sufficient evidence that something is working, even if I think that it shouldn't work, based on my model of the reality of the world, then I'm willing to reconsider my model.

Maybe my model is incomplete. 

Mrs. Madi Partovi: So thank you for doing that. Sure, 

Dr. Ryan Partovi, JD,NMD,MIFHI: sure. 

Mrs. Madi Partovi: Based on, something that yeah, I said, husband, I [00:49:00] wanna do this. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. No, yeah, that's exactly what, how that went down. 

Mrs. Madi Partovi: Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Thank you. No it is 

Mrs. Madi Partovi: a, it is a, the we are on a new friend here, or That's true.

And 

Personalized Medicine and Microdosing

Dr. Ryan Partovi, JD,NMD,MIFHI: It's fundamentally a frontier that is more personalized than anything that you're gonna find from the conventional establishment in this regard. As we've mentioned, people have different strengths and susceptibilities a dose that's effective for one person may be toxic for another.

So, there, reality of the matter is that using this microdosing method as off-label strategy to personalize the GLP one dosing, in pretty much any case, I would say is gonna improve. How well they're tolerated per, it's absolutely gonna prevent overtreatment and definitely reduce the [00:50:00] cost of the medication.

Again, for somebody who's paying out of pocket for it, if your insurance covers it well, I would just, there's so many, I would just say if your insurance covers it, use the lowest effective dose would be my advice. But if your insurance doesn't cover it, do microdosing first because it's gonna be a lot more affordable.

Mrs. Madi Partovi: So there's a lot of stories about it being covered initially, and then it they're not covering it anymore because, they're people are not within that range. Yeah, and then they're, it's like, okay what am I gonna do? There's a lot of that, 

Dr. Ryan Partovi, JD,NMD,MIFHI: right? 

Mrs. Madi Partovi: What am I gonna do? Yeah. Can't, I can't afford this?

Dr. Ryan Partovi, JD,NMD,MIFHI: That's a really good point. 

Insurance and Obesity Medication Coverage

Dr. Ryan Partovi, JD,NMD,MIFHI: So basically, if you're fall into the obese range of BMI, your insurance is gonna cover it. But the moment you lose the weight, now you're no longer obese, but you're just overweight, you're still not normal weight, but because you're not obese, the indication of the drug is it was approved for obesity.

If you're no longer obese, too bad it's not covered anymore because it's now off label because you're no longer obese. You think, oh, [00:51:00] that's a good thing. But the problem is that then the moment you get off the medication, you start gaining the weight again because you've not changed any of your habits.

And then. As a result, you just end up right back where you started, but then it's even harder the second time around because your body has become, tolerant to some degree to the medication. So, instead of that one size fits all approach, we believe that the, certainly I believe that adjusting the, to find the lowest effective dose for the individual is the best strategy.

And obviously it's going to ultimately I think, be cheaper, especially in the long run. And we have the, we have a great allied prescription fulfillment service, natural med choice that this video sponsored by natural med choice. Now I'm joking, but but I would say natural med choice is basically able to essentially work with compounding pharmacies around the country and find really great high quality US-based [00:52:00] pharmacies that do compounding and will make the sublingual and can offer it at like a, standardized price, which is really great too.

Regardless of how much you weigh or any of that stuff, okay, 

Mrs. Madi Partovi: so it totally makes sense. It reminds me of other areas of medicine where you find like the sweet spot, right? There's low dose naltrexone for auto autoimmune issues. So a tiny dose of a drug that's high dose, for other uses.

So microdosing semaglutide fits that idea, right? You start low, you go slow and you maybe stay low if it works, 

Dr. Ryan Partovi, JD,NMD,MIFHI: right? Yeah, no, exactly. With low dose naltrexone, we're literally using, again, it's a microdose 'cause it's a hundred times 50 to a hundred times less than the standard naltrexone dose, which is used for opioid withdrawal.

But it turns out that at that sort of very low hormetic dose hormesis is like the idea [00:53:00] that that a we'll say a toxin at a very low dose actually cau creates more healing than it does cause damage. And not that these are toxins, but basically that's the idea here is that, if you can use a low enough dose, I.

It's still gonna be doing beneficial things, but you're not gonna overshoot and have all the side effects, which are the side effects really come not because it's like, oh, this medication in certain people are definitely gonna get these side effects regardless of the dose. No, the side effects are indication that you are at too high of a dose or at least too high of a dose for your body right now.

Because this medication is so potent, just like naltrexone, right? You can act, oh, and I didn't finish explaining that with Naltrexone, you get a little bit of naltrexone and actually improves your body's own production of opioids. So it's an open question. I mean I, I'd be curious to see if, get some [00:54:00] research on this front in the next five, 10 years, whether it might be possible that, with these low doses with the microdosing, we may actually see some of the body's own.

It is body's own appetite regulation and insulin sensitivity regulation and that kind of stuff actually kick in and up regulate as a result of the low dose GLP ones. I think it's very likely. Yeah, so some people do, they try to do microdosing with injectables just to. Only a few clicks with the injections.

And there's this whole trend about click charts and how to dial tiny doses with the pins. But we think sublingual is just a lot more approachable. A lot of people don't like needles. A lot of people don't want to be injecting anything on a regular basis. And the sublingual route is definitely one we've used for a long time [00:55:00] with a lot of different hormones and certain nutrients.

But the delivery method that we now have available for these peptides, 'cause historically, again, peptides, we couldn't do peptides orally at all, even sublingually, because the absorption wasn't fast enough that you were going to, the peptide would basically get into the gut and it would just get digested.

So now we have these new sublingual carriers and vehicles that will allow that absorption and it's faster. We'll talk more about that in a minute, but 

Sublingual Semaglutide: Benefits and Techniques

Mrs. Madi Partovi: yeah, so we're transitioning into why under the tongue. Okay. And I think a lot of our listeners, a lot of our community are really curious.

Semaglutide isn't normally just a pill that you swallow, although, I think there once existed like a big old pill that you swallowed that you had to take in a special way. So what is the advantage of sublingual microdosing versus just taking a small pill or a tiny [00:56:00] injection?

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, so that's a great question. The main issue, like I mentioned, was the peptide drugs are really notoriously hard to absorb if you swallow them. So if you swallow semaglutide, your stomach and intestines are just gonna destroy most of it, and very little of it will get in the bloodstream. So even under ideal conditions, the oral semaglutide, you're only gonna get maybe 0.4 to 1% of it to get digested.

So that means, greater than 99% of it is never even gonna get absorbed. And so that's why they had to create that oral tablet Rybelsus that's 14 milligrams. Yes, 14 milligrams taken daily to get a similar effect as the one milligram weekly shot. So they had to overwhelm the gut barriers with brute force and this absorption enhancer in the pill in order to get it through.

Mrs. Madi Partovi: Wow, that's almost a hundred milligrams a week.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. [00:57:00] Yeah. It, points to how inefficient the gut absorption is ultimately for that particular molecule. And that's under perfect conditions, empty stomach, so. If we tried to microdose by swallowing orally, tiny amounts, it would be too low to matter. You'd be really absorbing practically nothing but sublingual under the tongue gives this an interesting option because when you put a drug under the tongue or even inside the cheek, you can cheek it, it can diffuse through the mucus membranes there and get directly into the bloodstream without going through the stomach and the liver first.

So we, we say it bypasses both the digestive destructive process as well as what's called first pass metabolism, which is when it goes first through the liver once, and it, a lot of it gets [00:58:00] inactivated. So, by doing this sublingual, you get a much smaller amount of the drug, but it's still, it can have a much more powerful effect because it's reaching through the circulation intact.

Mrs. Madi Partovi: So brands, it's like finding a side door, okay? Instead of like root force going through the front door where there's like a bunch of security guards and the security guards are like stomach, acid and enzymes and they're there waiting to beat you up. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

Mrs. Madi Partovi: Okay. So under the tongue it sneaks into the bloodstream more directly?

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, in a way it is like a workaround. That's a good, that's a good analogy. So, sublingual delivery has some challenges, to some degree are oral. Mucus is also designed to keep things out, so you have to formulate the drug in a way that it can penetrate, and that's where the compounding pharmacies have just really stepped up to help formulate this in a way that it [00:59:00] can with some there's a specific vehicle, which is like the base of the medication that it's put in, which is called Sub Magna Sublingual.

And it was developed by Professional Compounding Centers of America, PCCA, specifically to enhance sublingual absorption of large molecules like semaglutide. So it's this kind of special suspension that helps the peptide permeate, go through the the mucosa and then stay in contact so that it's not gonna be absorbed as easily or they're gonna go down as easily as well.

So it's gonna stick to the mucosa and then go through the mucosa. 

Mrs. Madi Partovi: Sub Magno sounds like a superhero name. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, 

Mrs. Madi Partovi: I know that. Harbor, maybe 

Dr. Ryan Partovi, JD,NMD,MIFHI: a sidekick name. I think 

Mrs. Madi Partovi: maybe, yeah. So Harbor compounding pharmacy, it's one of the biggest. Pharmacies. Hi, honey. Oh, okay, honey, [01:00:00] sweet prey. I just woke up a moment and what was I saying?

I'm so 

Dr. Ryan Partovi, JD,NMD,MIFHI: well before you go on. Yeah. I wanted to just mention, compounding pharmacies, just for those who may not or remember our previous conversations about them or maybe who haven't seen our previous videos. Compounding pharmacies are basically, if big pharma are the bad guys, small pharma would be the compounding pharmacies.

These guys are the ones that literally are able to make medications in the pharmacy, customize them, do them in the right way at the right dose for the particular patient. And they're usually run, they're usually family run and family owned. There's some that are a little bit bigger than others, but 

Mrs. Madi Partovi: Yeah, and most of them didn't politicize ivermectin at the time.

And yeah we're our allies. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. And I would say also big pharma's constantly trying to regulate them out of business. They, they would rather compounding pharmacies go out of business. [01:01:00] So, 

Mrs. Madi Partovi: yeah. There's a, there was a recent regulation right, that compounding pharmacies can't compound.

Dr. Ryan Partovi, JD,NMD,MIFHI: Oh yeah. So with Semaglutide they're not able to they're not allowed to do it. In the exact same injectable way as the commercial product. They can, but that doesn't affect us for microdosing purposes, but it's, it shows you how pig pharma plays. They play dirty. 

Mrs. Madi Partovi: Yes. Okay. Yeah. So Harbor compound sub 

Dr. Ryan Partovi, JD,NMD,MIFHI: magna, 

Mrs. Madi Partovi: sub magna, 

Dr. Ryan Partovi, JD,NMD,MIFHI: you said the 

Mrs. Madi Partovi: Yes.

Harbor compounding pharmacy is one of the biggest compounding pharmacies. They use that base for their sublingual semaglutide. And they even claim that it has something up to like 10% absorption as opposed to like 1%. Orally. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. So they publicly shared some figures using the sub magna sublingual formulation.

And and you're right, I mean they indicate you might get something on the order of [01:02:00] 10% absorption sublingually versus the 1% if you just swallow the tablet, which is a huge improvement. And it means that, a 0.5 milligram sublingual dose could deliver as much active drug in your system as a five milligram swallow dose.

So it makes that idea of lower dosing, more plausible. Does that make sense? 

Mrs. Madi Partovi: It does, yeah. They harbor also noted that with sublingual semaglutide that the levels can peak in as little as 30 minutes. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

Mrs. Madi Partovi: Which is much faster than the oral, oral route it takes. 

Dr. Ryan Partovi, JD,NMD,MIFHI: You've been doing your research.

Yeah, that's great. Yeah, so, look, this definitely is smoother. 

Mrs. Madi Partovi: Who doesn't like smoother, right? Yeah. Less extreme absorption profile, 

Dr. Ryan Partovi, JD,NMD,MIFHI: right? Absolutely. 

Mrs. Madi Partovi: Your wild spikes and drops and that could be a more stable effect. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. And we call this pharmacokinetics, that's like how the drug is metabolized by the [01:03:00] body.

And so when you inject semaglutide under the skin, it's formulated to absorb really slowly, which is why one shot lasts a week. So the injection peaks around one to three days post dose and has a long tail. With sublingual, especially at micro doses, you get a quicker entry and likely a more daily cycle.

So think of this as like short acting versus long-acting. Sublingual microdosing is typically then gonna be done either daily at the high end, or we usually start out with the twice a week, and then gradually maybe increase it if need be versus the once a week. So, yeah, typically gonna start it out twice a week and then increase as needed.

But I think that fast onset peak of 30 minutes means, you take it in the morning, you get curved appetite maybe for the whole day. I. And most patients prefer doing it in the morning for that reason. [01:04:00] 

Mrs. Madi Partovi: Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Unless you want to have a big breakfast for some reason, I don't know.

Probably not if you're trying to lose weight.

Mrs. Madi Partovi: Yeah. So, so thank you for that acknowledgement, because I have been doing quite a bit of research, listening to various podcasts and doing a lot of reading, even before approaching you with this idea. True. Okay. And I just find the science.

I, so what I'm really saying is that I had to champion my own my own blanket judgments and my own just taking a look at, okay, where and how can this actually be beneficial? Yeah. So I find the science really fascinating. Yeah. And I really want you to talk about the RAT study.

Dr. Ryan Partovi, JD,NMD,MIFHI: Okay. 

Rat Study and Bioavailability Insights

Dr. Ryan Partovi, JD,NMD,MIFHI: PCCA did conduct a study in rats as like a proof of concept. They gave the semaglutide to rats in three different ways. They did sublingually using sub magna base orally like a crush tablet, and then by injection. And they found that the [01:05:00] semaglutide was detected in the rats bloodstream as early as two minutes after the sublingual dose inclu, which, means that there was rapid absorption.

They also found that the total exposure area under the curve, which means how much drug got in total was with the sublingual, was significantly higher than the oral tablet at the same dose, which, implies that there's greater bioavailability. And they also found that there was less variability between the different subjects, in this case, rats with the sublingual versus the oral.

So sublingual is very consistent across, different animals, different humans I think as well. So in this study they were looking at the rats and they found that absor, oral absorption varied tremendously. And some got a lot, some got almost nothing. So, long story short, the rat study really validated that the sub magna vehicle enables the semaglutide to get into the [01:06:00] circulation via the tongue and mouth area, that sublingual area.

Mrs. Madi Partovi: That's awesome. I know it's just rats, but it's a good signal that it works biologically. 

Yeah. And that their conclusion was that sublingual under the tongue semaglutide has improved bioavailability versus like the oral tablet. And without the, the gut loss. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah.

And just to be clear, when we say bioavailability, we mean absorption, assimilation, it's basically getting through, it's getting into getting through the gut into the bloodstream, getting from the bloodstream to the cell, the tissues in the individual cells, and is able to then do what it's, it needs to do at the cellular level.

That's what we mean when we say that. I don't, I wanna make sure that everyone's clear on that. So this was not necessarily a dose finding study for humans, so we can't exactly say that, X micrograms and rats equals Y in humans, but it did make it clear [01:07:00] that this is a, it's a doable way of approaching approaching the dosing.

And it gives us a guesstimate. And that's part of why, because it is a guesstimate and we're well aware that it's a guesstimate. We start on the lower end. We start with twice a week versus every day. We start with, five to 50 depending on the person, usually around five micrograms a day.

Mrs. Madi Partovi: Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: So, 

Mrs. Madi Partovi: so I, I do want to mention that there is a little bit of technique, for under the tongue. It's not something you just drop and swallow immediately. It, 

Dr. Ryan Partovi, JD,NMD,MIFHI: You know what, I need to clarify what I just said. 

Mrs. Madi Partovi: Okay. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Because it was confusing. Okay. It's 50 micrograms with the expected delivery of five micrograms.

That's typically the starting dose. I realized that was confusing. I was like, yeah, I need to actually clarify that. Go ahead. 

Mrs. Madi Partovi: Okay. Tongue technique. Yeah. You, ideally you drop it and then you hold it to for five to 15 [01:08:00] minutes. If possible. Definitely no less than 30 seconds. And the longer you keep the solution in your mouth like that, it's, the membranes are bathing in it and the more the drug can absorb.

Okay. So they even gave tips like do it on an empty stomach to reduce saliva and swallowing. Avoid eating, drinking for 15 to 30 minutes after, and then maybe hold it while you're reading or watching TV to pass the time. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Or listen to a podcast. 

Mrs. Madi Partovi: Yes. Part Toby effect. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, I would say, maybe a good compromise would be two minutes.

I think five to 15 is, is a lot, but I think, and I'm sure you will get more of a benefit at five to 15 at a lower dose, excuse me. But I think most people can probably hold something in their mouth for two minutes and after that it's probably it's increasingly difficult. So don't think you have to do five to 15 in order to get a [01:09:00] benefit.

That being said, if you just squirt it in your mouth and immediately swallow it like a drink, you're turning it into an oral dose and we know that doesn't really absorb very well. So technique is important. And certainly in our practice, we coach patients how to take the drops. Finding a consistent time, usually morning, avoiding eating around that time.

Hold it as long as you comfortably can clean at least a couple minutes. And it's really not as bad as it sounds. Most patients do fine. Some even say that they make it part of their morning ritual. They drop it in and then listen to a short podcast or, meditate for five minutes and. I think 

Mrs. Madi Partovi: medic I am a pro that, medication in a mindful moment with yourself.

No needles. I'm a needle fobe. Yeah. Yeah. I had some trauma around that in the hospital when I broke my leg. Yeah. So I know that some folks who shy away from Ozempic [01:10:00] because, they they hate, needles or they get in injection site reactions. So sublingual, totally sidesteps that.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, absolutely. So we've had patients that specifically reach out to us because they're looking for alternative to injections, and then of course, obviously we're glad to be able to prescribe or provide them with the sublingual. 

Mrs. Madi Partovi: Yeah. 

Microdosing Protocols and Patient Experiences

Mrs. Madi Partovi: So it's really heartening because we are we're running a pilot for the Metabolic Microdosing program.

And most of the people who have registered signed up for it. They already have great habits, they have great fitness habits and it's just that, that 20 pounds, that they just can't seem to get rid of. And, they've been afraid of the injections. They, just wouldn't go anywhere near Ozempic.

So when this came about, oh, okay. Yeah. Yeah. So for those pilot participants, thank you, for your trust. [01:11:00] Thank you for being part of the Aspen Wellness Institute community in such a, an extraordinary, powerful way, an engaging way that you're willing to go on this journey with us.

You're willing to take a look at, take a look holistically, your relationship with food. Yeah. I just, I love that. I love that. I'm so excited for you and for us. 

Dr. Ryan Partovi, JD,NMD,MIFHI: This episode, by the way, sponsored by Aspen Wellness Institute.

That one's actually true, but anyway that's the name of our practice. So yeah, absolutely. I think it's great that people are willing to throw their hat over the wall and say, Hey let's give it a shot. I think that's that's the only way you actually transform things in life is being willing to like,

Mrs. Madi Partovi: yes, to take the [01:12:00] 

Dr. Ryan Partovi, JD,NMD,MIFHI: plunge.

Addressing Metabolic Dysfunction Holistically

Mrs. Madi Partovi: I'm excited because I'll be able to guide people through and teach mind work and support people with clearing their baggage, maybe years long, maybe just any. All those years, that have led people up to any metabolic dysfunction. We're gonna really take a look at that.

Yeah, we're going to take a deep look at that and we're going to address that like head on and I love that kind of work. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, and you're great at it. 

Mrs. Madi Partovi: Thank you. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Alright getting back to the sublingual ozempic, I would say, or semaglutide rather the nice thing about that I wanted to make sure we mentioned was that just it provides a lot more flexibility in dosing frequency, which we get into now and really see what is typically the dosing, what does it actually look like specifically, and then what kind of effects do we commonly see at the lower [01:13:00] doses.

We touched on the fact that the standard dosing for weight loss is, hundreds or thousands of micrograms a week, which is to say, it's in the milligram level. So, 2,400 micrograms or 2.4 milligrams per week is the target wegovy dose microdosing protocols using much lower numbers.

So, concretely, typically patients will start at 50 micrograms, which is 0.05 milligrams per week. Or maybe twice a week for a few weeks. And then, if they're really already starting to lose weight, they're already feeling better, less inflamed, everything, keep 'em there, right? If no, not really noticing anything after a couple weeks, no weight loss, nothing, no changes, then we go ahead and go up to a hundred micrograms.

And the nice thing about it is, it's like literally, we go from [01:14:00] 0.1 mil of the solution to 0.2 mil of the solution, right? Or we go from, one drop to two drops if we're doing the droppers. And and then we can just gradually titrate up. And each of these, even if you're doing many different mini drops, there's still gonna be less than one injection of the typical starter dose.

So, some people maybe other practices use a little bit more. And certainly there is that option, but we always start people off low and slow. That's my philosophy when it comes to anything, again, lowest effective dose. So, and then you can, you have the option of obviously increasing it.

All the way up to as high as you need to get results. But the idea is to gradually increase it and to increase it under the guidance of a physician to help you figure out, do we [01:15:00] need to reformulate? Do we need a higher concentration? That kind of thing. So,

Mrs. Madi Partovi: under the guidance of a physician.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. I think that

I think that's something that we're seeing more and more. We talked a little bit about that earlier, but I just think that it's wild that people, and I get it, especially with the advent of AI and the large language models and the sense of like, oh, I'm just gonna go ask AI what I should do with this medication.

I just follow its protocol. AI makes a lot of mistakes. I would just tell you, you may not, the thing is if you're not a doctor, you're not gonna notice the mistakes that it makes on medical stuff. But ask it questions about something that you're an expert in, and you'll see what I mean.

So. The other thing I would also just say is that the way you ask the question matters. And so, like, as a doctor, I'm gonna ask questions about medical stuff differently than how you'll ask it. And so I'm gonna get different answers [01:16:00] and the answers are only as good as the questions.

So, 

Mrs. Madi Partovi: yeah. So I just wanna simplify that. Microdosing might involve tens of micrograms per day or a few times a week. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Usually starting out a few times a week and then, gradually increasing. 

Mrs. Madi Partovi: So it, it's adding up to maybe a couple hundred micrograms a week, whereas the standard treatments are hundreds to thousands of micrograms in a single weekly shot.

It's literally like a tenfold difference 

Dr. Ryan Partovi, JD,NMD,MIFHI: right Out or more, 

Mrs. Madi Partovi: That's super wild. It's like comparing a little sip or how our 3-year-old will say a little hip of medication to checking a big glass. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. So, I think the most important thing to note, because it's probably right there for a lot of people, is what, the big question is like what's, are you really getting any benefit from these tiny doses?

And absolutely. Because the [01:17:00] mechanism that Semaglutide is, or by which the GLP one agonists support. Weight loss, and frankly, other effects as well through app appetite suppression doesn't necessarily require that maximum dose to start working. Even if your appetite is, let's say your typical appetite is a hundred, even if you're going from a hundred to 90, or a hundred to 85 or even 195, you're dialing it down.

Very likely you're either gonna, if you've been gaining weight, you'll stop gaining weight. If you're ha, if you've been holding steady, you'll start losing weight. Even if you have a small reduction in your appetite you don't need that maximum dose. So, long story short, even at these low doses, the semaglutide is gonna help dial back down your appetite and begin the weight loss process, or at least help you stabilize your weight.

If [01:18:00] you've been, ballooning up, it's gonna help stabilize. And then we may have to, if you've been ballooning up, we may have to go a little bit higher to get the weight loss, but, meantime, we're gonna be addressing your why. It was that you were ballooning up, right? Yes. Like why were you gaining all that weight?

It's, either eating the wrong foods or. Doing the wrong kind of exercise or not enough exercise or but it's usually the wrong foods. 

Mrs. Madi Partovi: Yeah.

Dr. Ryan Partovi, JD,NMD,MIFHI: And especially too much of the wrong foods of course, but it's usually the wrong foods. Nobody becomes obese, biting too much broccoli.

So it's like you're, 

Mrs. Madi Partovi: we are going to be addressing all of that. Yeah. Metabolic micro in 

Dr. Ryan Partovi, JD,NMD,MIFHI: our, in our program. We do. Yeah. 

Mrs. Madi Partovi: And I just wanna really emphasize that the side effect profile is dramatically lighter. Okay. People have the right, not to go through these intense side effects.

And you don't have to. Yeah. You don't have to. [01:19:00] Okay. So I'd like to ask of what you've observed in the sense of side effects when it comes to microdosing. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Microdosing is just super ridiculously well tolerated. You keep the dose low, you ramp up slowly, again, low and slow.

The nausea, the bloating are either kept super minimal or just completely avoided. Hardware compounding actually notes in their sublingual formulation. It. May minimize common GI issues such as nausea and bloating compared to injections. So that's even in their literature. And we've seen the same, there may be a hint of nausea at the very beginning for extremely sensitive people, but it typically dissipates, in a day or two.

And then, and it's much milder, much more tolerated. Maybe have a little ginger and we'll offset that. Or you can do a little stimulation of pericardium. Is it pericardium? Five or six? Do you remember? It's an acupuncture point or acupressure. It helps with [01:20:00] nausea. Don't hate me. Five.

Yeah, I think it's five. That's what I think, but if you're a TCM person, don't don't send any comments about that. It's been a long time since I've done acupuncture anyway. So most patients on myosis tell me they don't feel like they're on a medication. Maybe that their cravings are down a little bit, their energy is actually up.

So yeah. 

Mrs. Madi Partovi: Yeah, that's fantastic. There were, you only got a tiny little bit of the horror stories in the beginning. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Real horror stories. Yes. Wild. So 

Mrs. Madi Partovi: microdosing could be a gentler introduction. Perhaps even a phase one. For somebody who eventually wants to go higher, it's like getting your body used to it on a very low level.

Dr. Ryan Partovi, JD,NMD,MIFHI: And the beautiful thing about the sublingual microdosing is it does allow you to eventually go higher, without having to mess around with needles and [01:21:00] without overshooting your therapeutic window. By jumping up, by, 250 micrograms every time you increase your dose, you can go up by 10 micrograms every time you increase your dose.

So, I think it's using it as a way to titrate and have this extended gentle ramp, and then you reach a point where it's like, oh, it's working great. Stay there. If at any point it stops working, you can start to increase again. But yeah, there's no doubt that it reduces the risk of side effects.

Yeah, trade-offs, right? Biology, everything is, there's trade-offs in biology and often in most parts of life. Sometimes it does take longer to reach a full therapeutic effect. So, for someone who maybe has been ballooning up, as we mentioned. It may be that initially what they see is that things start to level off for a little bit, and then we have to keep, gradually increasing it in order to start to see weight loss.

So, and again, that's all facilitated by [01:22:00] the healing their gut and tidying up their diet. And but then of course there's people who want to just stay at low doses. And those, that's the next thing I want to talk about is there's people who take the low doses for other things other than weight loss.

Yes. 

Microdosing for Inflammation and Cognitive Health

Dr. Ryan Partovi, JD,NMD,MIFHI: We focus a lot on weight loss, so we really need to talk now about the benefits and uses of the microdosing beyond just the, yeah. So the weight management side of things. 

Mrs. Madi Partovi: How would people take this, if they're interested in, 

Dr. Ryan Partovi, JD,NMD,MIFHI: oh and I should, we should put at the beginning of this episode that for those of you who don't have to any lose weight to lose, jump forward to this point in the episode because I think that you will see benefit from it, but I will say that it's the conversation up till now may not have been as interesting for you.

Mrs. Madi Partovi: Yeah. So there are longevity and anti-inflammatory angles to this. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, exactly. So, in, in the, in our circles, integrative holistic natural medicine world, [01:23:00] there's actually quite a bit of excitement around the idea that GLP one agonists actually do more than just help you lose weight. I. So it turns out that at lower doses they have the subtle effects on metabolism and inflammation that we believe and we hope likely contribute to overall health span.

Which is to say how long you stay healthy over the course of your life. So, let's touch on a few of those. Anti-inflammatory effects. So the research on GLP one agonists is that they actually reduce markers of inflammation like C-reactive protein and also interleukins, which are cytokines, which are like the chemical messengers of inflammation.

Semaglutide is shown modulation, so it can usually turn down, sometimes can turn up if we need to with an infection, but usually it's turned down inflammatory pathways and that's one of the reasons why it can help in conditions like fatty liver and also reducing cardiovascular [01:24:00] disease risk.

So, microdosing helps you tap into those benefits without aggressively pushing the weight loss if that's not something you necessarily need. So, using those micro doses for inflammation often will help patients with autoimmune diseases, chronic pain who don't necessarily want to. Exacerbate their whole health picture with some of the side effects from these higher doses, but they're like, Hey, I'd like to get some anti-inflammatory benefit, but like, not have to deal with all the nausea and, constipation, everything else.

That's just gonna make everything worse. So we've, we've definitely seen some reports of improvements in joint pain, reductions in it, and also other autoimmune symptoms and people using low dose semaglutide. Any questions about that? No. Okay. Another area which is promising is looking at cognitive health.

So there are GLP one [01:25:00] receptors, as I mentioned in the gut, but also in the brain. And there's also some emerging research, again, early stage that activating these GLP one receptors in the brain could reduce neuroinflammation and hopefully lower the risk of neurodegenerative diseases like Alzheimer's and Parkinson's.

So it's even being studied for its effects on Alzheimer's disease. And the idea is microdosing might gently engage those brain receptors that over the long term would confer some neuroprotective benefit, reducing your risk of developing Alzheimer's or Parkinson's. It's speculative but fascinating.

Any questions about that one? 

Mrs. Madi Partovi: No. 

Dr. Ryan Partovi, JD,NMD,MIFHI: No. Okay. 

Metabolic and Cardiovascular Health Benefits

Dr. Ryan Partovi, JD,NMD,MIFHI: Metabolic and cardiovascular health. We've talked a little bit about ins insulin sensitivity, a lot of times when you have even a little bit of improvement in insulin sensitivity you get improvements in blood sugar control and then that's gonna dramatically improve things like metabolic syndrome or pre-diabetes.[01:26:00] 

So, with using microdosing, you don't have to wait until the person has full blown type two diabetes. If they have insulin resistance, if they have metabolic syndrome, they have pre-diabetes, you can use the semaglutide as that GLP one agonist at those low doses to improve insulin action. And it's gonna lower blood sugar also improves lipid profiles, reduces oxidative stress.

So, the advances, the formation of advanced glycation in products or AEs, the molecules of aging is gonna be reduced through the low dose GLP ones. So microdosing is gonna help somebody who's maybe been, on the border of being diabetic, is pre-diabetic or maybe insulin resistant without pushing em into that full pharmaceutical therapy territory.

It's like a tweak, it's like a tuneup to your metabolism. And, [01:27:00] inside of that, it's not a shock that they improve cardiovascular health, reducing risk factors. And even, in, in diabetics we have some good data showing that it taking GLP one agonists reduces their risk of cardiac deaths.

So that's pretty exciting. And, if you're using a low dose, it's gonna be having some benefit on those pathways. Yeah. 

Longevity and Anti-Aging Potential

Dr. Ryan Partovi, JD,NMD,MIFHI: And that's a pretty good segue to the last area I wanted to discuss on this front, which is the longevity anti-aging benefits. So, we have this notion in the anti-aging world that controlling nutrients and metabolic signals modulating those can affect aging.

And there's a lot of experts, myself included, who believe that the GLP one agonist could ultimately become part of like a standardized longevity toolkit by maybe improving mitochondrial function, reducing oxidative stress in cells. We have at least one study showing that there's also [01:28:00] anecdotal reports from early adopters that are, from the biohacking community that say that the microdosing of the GLP one is.

Is actually result resulting in slower aging, greater vitality. It's pretty anecdotal, but I would just say that's, that is, I think one of the potential benefits of this is to optimize healthy lifespan rather than just treat disease. And that makes sense because if you're mitigating a lot of the mechanisms by which chronic disease develops, you're gonna reduce your risk of chronic disease, which means you're gonna slow down your aging process.

Right. 

Mrs. Madi Partovi: That's so fantastic. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

Mrs. Madi Partovi: That's great. We're basically saying that med producing semaglutide is like analogous to taking a, an everyday nutraceutical.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

Mrs. Madi Partovi: For wellness 

Dr. Ryan Partovi, JD,NMD,MIFHI: there are probably nutraceuticals [01:29:00] that have a more, that, that have a, that are stronger dose for sure. There are. Than the semaglutide. But yeah, it's gonna have a, it's gonna have pretty broad effects, which is cool. And it would synergize with things like, whatever people are taking, whether it be green tea or burberine or whatever.

Mrs. Madi Partovi: You're laughing. I just have a song in my head. Okay. You wanna sink it, just start drop. Semaglutide keeps the inflammation away a little metabolic boost, maybe cognitive protection. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Mary Poppins, it's 

Mrs. Madi Partovi: officially proven, but a plausible extrapolation of what we know GLP one does. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, exactly.

So, obviously we need to keep doing more research. We will be doing more research. Right now we've got a mix of some small studies. We understand the pharmacology. We have some good anecdotes, [01:30:00] some case studies. And frankly, the patient reported outcomes from the microdosing has been pretty positive.

So people experience things like improved energy, reduced fatigue, better overall sense of wellbeing. Patients with autoimmune issues report that they have fewer flares, or the flares are less intense. The pain during them is less intense. And so even at low doses we see these, lots of reports of weight stabilization, gradual weight loss.

Definitely people stop gaining weight or they start to lose a few pounds, which is really what the goal should be, right? You may not lose 50 pounds in three months, like if you're doing full dose wegovy, but that's not healthy anyway. But if you lose five to 10 pounds over. Three, three to six months without any major side effects, that could be huge.

And, to continue that obviously is also really positive. [01:31:00] And frankly, the more weight you have to lose, the more this is gonna be beneficial to you. I would say, although that being said, I would say it makes the whole program more important. I think that the people who will who only have a little bit of weight to lose, they're gonna see it's, will be a faster response and it'll be probably at a lower dose.

But if you have more weight to lose, then the long-term potential is really great for using a approach like this that that empowers mind, body, spirit, holistic approach plus the semaglutide to really synergize the process. 

Mrs. Madi Partovi: Great. Yeah, and I also imagine that this would be appealing to potential patients with complex chronic illnesses.

Microdosing for Chronic Illnesses

Mrs. Madi Partovi: Like, there is somebody in our community that asked would this work for somebody well with mold illness and autoimmune illness? Excuse me, you touched on autoimmune a bit, but what about mold [01:32:00] toxicity people? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, so good question. In the case of any kind of chronic inflammatory illness, whether it's, triggered by mold exposure, Lyme, chronic Lyme, where people have a deranged metabolism and there's lots of systemic inflammation.

It makes sense that as an adjunct or part of the overall treatment, you could, that using some GLP one agonist, low dose off-label is something that is gonna lower inflammation and improve mitochondrial function and metabolic balance more generally, which is gonna also help them heal.

So, and also if they've gained weight or if they're very inactive, just helping to reduce appetite a little bit with the GLP ones at a micro dose and is gonna give them that kind of mild appetite reduction metabolic boost to stop the weight gain and begin the recovery process. [01:33:00] So, because oftentimes patients that are mold susceptible or have biotoxin illness tend to be like canaries in the coal mine, myself included, very sensitive.

Microdosing is really, I would argue the only way that those patients should even consider a GLP one agonist because the standard dose would probably just wipe them out with side effects. 

Mrs. Madi Partovi: Yeah,

Dr. Ryan Partovi, JD,NMD,MIFHI: in fact, I would say people 

Mrs. Madi Partovi: dealing with mold toxicity can barely tolerate medications well, 

Dr. Ryan Partovi, JD,NMD,MIFHI: yeah, oftentimes.

And I would just say that if you've tried semaglutide and it did knock you on your butt, then you might be mold susceptible or you might be, biotoxin susceptible and not realize it.

Mrs. Madi Partovi: Wouldn't wanna know that. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. That's, that's something we look at in our wellness practice.

But, I think in the meantime we've absolutely seen that

some people with biotoxin illness, chronic inflammatory response syndrome [01:34:00] do respond well to microdose semaglutide reporting less brain fog, more energy. And we think that this works by, through the same mechanism by which the GLP one agonists are gonna be reducing that neuroinflammation.

And neuroinflammation is of course one of the main symptom causes of symptoms in mold illness. So it's really the same mechanism by which the GLP one agonists relieve autoimmune conditions. It's, there's a lot of those same cytokine driven pathways, and that's the same way that's gonna be, that they're gonna be helping in in mold related illness as well.

So it's obviously not a cure for mold toxicity. You've gotta, get your area, find the mold, get it remediated, do the whole detox protocol. But it can definitely be supportive therapy as you rebuild your life [01:35:00] especially for those who've gained a lot of weight as a result of mold exposure, which of course is not something most people realize, but it is something that is very real.

Mrs. Madi Partovi: Yeah. Thank you. Yeah, that's that's, it's 

Dr. Ryan Partovi, JD,NMD,MIFHI: actually, and the mechanism is really clear. The mycotoxins suppress MSH, which induces leptin, or it's actually leptin resistance. Leptin resistance suppresses Ms. H, and then you get all sorts of other horrible side effects from the mold. But yeah, 

Mrs. Madi Partovi: Still that's very encouraging, for this very important group of people like dealing with mold.

Yeah. Yeah, I just, I have a lot of compassion for those people because a lot of their community and even family members don't believe them. That they're dealing with this and you really get them on a whole different level. 

Dr. Ryan Partovi, JD,NMD,MIFHI: I do. 

Mrs. Madi Partovi: Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. You remember that patient that we had? We obviously can't say any names, but she gave our son a [01:36:00] Palmer jacket when she was yeah, he was, when he was little.

Really sweet patient. I never forget her, but I would say she's a classical example of a patient that was, that had mold illness that also struggled with her weight. And I think that she's exactly the kind of patient that I would say would, benefit not just from mold remediation and getting outta the moldy room, space and doing the cho tyramine and all that, the rest of the shoemaker protocol, but the GLP ones, because there is that relationship between the weight gain and the mold.

And I think that's something that a lot of people, it doesn't happen to everyone. Keep in mind, you may live in a moldy house and you may be skinny as a rail, but for the subset of people whose weight is enhanced by the mold presence, which we think is probably genetic I think that the GLP ones could be helpful in multiple ways.

Mrs. Madi Partovi: Yeah. Okay. 

Considerations for Significant Weight Loss

Mrs. Madi Partovi: Moving on you mentioned earlier that if somebody's primary goal [01:37:00] is to lose a lot of weight, like substantial weight is this the right approach? Because. It may not produce, dramatic weight loss like the standard dosing does. And I just wanna say, I don't know why people would want to do that.

It's like I take a double take, somebody's who's been heavy for quite a long time and then whoa, they lose a hundred pounds, and three months. It's

Dr. Ryan Partovi, JD,NMD,MIFHI: yeah, look, I'm not here to make anybody wrong. I would just say that excuse me. To be fair, microdosing will definitely lead in most people to much slower and less pronounced weight loss starting out by itself, right? If all you're doing is microdosing semaglutide, now if you combine it with a gut cleanse, some dietary change, a new exercise program, I think you're gonna see a much different result.

But by itself, you're gonna see slower, [01:38:00] less pronounced weight loss than with the full dose protocol, full dose protocols. I'm not disputing that. And look if you have somebody who's morbidly obese and it's like, oh, I'm either need to do this or get some surgery, you can use the traditional regimen if you can tolerate it or maybe even use tirzepatide.

But look I would always, typically, actually recommend people do semaglutide first, and then if they plateau on semaglutide, then try tirzepatide. So if Tirzepatide, I don't wanna talk too much about it, but I will just say it works on multiple different hormones, not just GLP one. 

Exploring Glucagon and Weight Loss Trade-offs

Dr. Ryan Partovi, JD,NMD,MIFHI: It also works on glucagon and I think maybe one other one.

But look, not everyone needs, but also has more side effects, right? Because these trade offs, right? 

Mrs. Madi Partovi: Yeah. And without addressing it holistically, there's, you're going to have a regression. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Not only that, or you I would [01:39:00] say this. You're either going to have to stay on it for the rest of your life or you're gonna have a regression.

Mrs. Madi Partovi: Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: But not everyone wants, or needs or should have rapid, dramatic weight loss. If you don't want saggy skin and you don't want frankly

bone loss and muscle loss, 'cause that's part of what you're losing. If it's that fast 

Then I think it makes sense to stick with half a pound a week to a pound a week, steady weight loss. Which I mean with the high dose of Wegovy, you see some patients see even four to five pounds a week, which is insane.

There's nobody who thinks who's been in Bariatrics for long who thinks that's healthy weight loss. If they do, it's because they've been doing they're surgical bariatrics. But I would say that, anybody in the nutrition, on the nutrition side of it is like, that's not healthy.

Somebody's not eating enough. Be, and because that has [01:40:00] negative effects in terms of disease risk and immunity and bone density and muscle muscle mass and all that. It's, that's the problem with it. 

The Case for Microdosing Wegovy

Dr. Ryan Partovi, JD,NMD,MIFHI: So yeah, microdosing is really, I would say in an ideal world where money wasn't an issue, I would say anybody who's considering using the medication should try microdosing first.

And see how that goes. And the people that are trying to, trying to break a plateau make sense to try it. And I think those are the people who are gonna get the most benefit out of it. But and then if you do reach a point where a dose is not working anymore, you can always increase it if you need to lose a little bit more weight.

But I think that, for people who are very high risk, they have multiple comorbidities and they, the risk of keeping the [01:41:00] weight on another day is greater than the risk from the medication, which there is that category. I would say people who are morbidly obese probably fall in that category. And that's a BMI of I think over 45 off the top of my head.

I think that's right. For those people they may want to go to full dosing, they may wanna do the injectable. It makes some sense there. But if your issue is like, Hey, I'm overweight or I'm obese, but it's like, BMI 30 to 40 I think if tolerability is important, overall wellness is important to you.

If maintaining your muscle mass and your bone mass are important to you, then microdosing is, should be the way to go at least initially. It really depends on your goals and what you're committed to in terms of your overall health.

Mrs. Madi Partovi: Yeah. Yeah.[01:42:00] 

I just have this picture of Neil in the Matrix, like stopping all those bullets from Agent Smith. It's like, you can't like take pause,

take pause and take a look at, what it is not only what is available, but what what you're worth.

Yeah. So I did do a double take, when you said, when you were talking about Tirzepatide. And it ties into, that listener query. 

Tirzepatide: The New Kid on the Block

Mrs. Madi Partovi: So why not, why not just use Tirzepatide or Z Bound instead, just for those that don't know. Tirzepatide is a brand name manjaro for diabetes and z bound for obesity.

It's the new kid on the block that hits two hormones. GLP one and GIP. It's been shown to cause even more weight loss on average than semaglutide. So someone might wonder if we're after [01:43:00] weight loss, or metabolic benefits, why not just go boom straight there? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. So I think if Tirzepatide is like kind of the next level up after Semaglutide.

For weight loss specifically because it is targeting two different hormonal pathways. The first thing to know is at this point, because Tirzepatide is very new it is only available as an injection and in relatively high doses. So they start it at 2.5 milligrams a week for diabetes and it goes up to 15 milligrams a week.

In some of the obesity trials, there is no oral or sublingual form available. So you know, if your goal is to avoid injections or use small amounts, there's only game one game in town, which is semaglutide because we have to have that flexibility to put it into drops and do the sublingual.

There's more to it. I would say that the the interesting thing about [01:44:00] Tirzepatide is because it's targeting two hormones it is gonna have more side effects typically more GI side effects and at the same doses as semaglutide also because. There's really been one big study, which was like the approval study on it.

We don't have nearly as much data as we do on semaglutide, it's a newer drug and with greater effects, we may, we see greater trade-offs. So we'll just have to see. I think at the point where it becomes, we get oral tirzepatide drops I think it'll be interesting to see, if there's people who plateau on semaglutide on a weight loss perspective might there be some benefit to switching them to tirzepatide?

Maybe, we just don't really know yet. But yeah, it's something to keep an eye on. It's something we'll definitely keep an eye on as we go along. And we [01:45:00] haven't had that problem yet where somebody basically maxed out. I have seen it on the pharmaceutical side where people have maxed out on semaglutide with the 2.4 milligrams.

And I have, I don't treat these PA patients directly because we don't do the injectables in our practice. But there's people that I've said, yeah before you consider bariatric surgery, you may want to consider tirzepatide. But the other thing I would say is because it's targeting two hormones.

You may not have as much of a GLP one effect. It it's split between two different receptors and therefore you may not see as many of the anti-inflammatory neurological benefits, anti-aging and everything we just talked about cognitive. You might not see as much of those benefits with a tirzepatide [01:46:00] versus the semaglutide.

So, we just, it's one, it's something we will keep an eye out. We'll be watching, we'll, as it becomes available compounded microdose, we'll consider it whether there's certain patients that it may have a benefit for. But right now it's just not available, so.

Mrs. Madi Partovi: Oh, okay. So it's partly availability and mostly caution, like, don't jump on that train until you have a ticket to informed consent, and Semaglutide is a bit more established. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Oh, definitely. Yeah. It's like, it's like Ivermectin versus Paxlovid, right? It's like, which one's been around for a lot longer and which one do we have a lot more data on?

And, semaglutide is the one that we definitely have a lot more data on compared to, tirzepatide. So, but yeah, look, there's, like I said, there's been people where they've tapped out on mega dosing semaglutide, they've lost. A huge percentage of their body weight, but they still need to lose more than I might consider recommending Tirzepatide especially if they're, diabetic.

But I [01:47:00] would say that if your goal is to is for the gentler non injection approach, then sublingual semaglutide is what we have available. So, it's currently the micro doer's choice because we have this cool compounding base and we have evidence to support it and we may see tirzepatide join that club, but it's gonna be at least a year or two at a minimum, I would say.

And for now, semaglutide is the one that is available for compounding for the microdosing. And a lot of people don't need that extra potency after tirzepatide. Why not s save that? Why not hold that in reserve and use it if you're not getting, you, let's say you ramp up the dose on the semaglutide and you reach a plateau and increasing it is not helping, then you might want to consider tirzepatide.

But the same way where you don't want to overshoot that therapeutic window. We talked about that with regard to Ivermectin [01:48:00] earlier. It seems silly to go straight for the most powerful drug on the market when you could still get a lot of mileage out of the semaglutide. And reserve that tirzepatide for if you really needed it.

And frankly, look, semaglutide by itself for moderate appetite suppression, metabolic tuneup, it does the job. So there's no need to go to Tirzepatide and there's a very real risk of it being overkill, and frankly not worth all of the additional potential side effects and also uncertainty about long-term side effects.

Mrs. Madi Partovi: Yeah. Okay. So that covers it well. So it's your zip dead or the big guns. And if you think that you need them, but how would you even know, how would you even know that you can handle them in the first place?

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. It's really to me about if you've maxed out your dose on semaglutide and you're no longer losing any weight and you've still have more weight that you need to lose.

Mrs. Madi Partovi: So [01:49:00] starting it's a very 

Dr. Ryan Partovi, JD,NMD,MIFHI: small group of people. 

Mrs. Madi Partovi: Yeah. So starting with a milder needle free journey, the microdosing, some blue tight, it seems like a really practical and safe option to begin with. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, absolutely. 

Mrs. Madi Partovi: Okay. 

Sublingual Semaglutide: Bioavailability and Effectiveness

Mrs. Madi Partovi: You talked about bioavailability earlier, so isn't the oral bioavailability too low to matter?

I. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, so the key is the, is sublingual versus oral, right? And then the formulation not every pharmacy, not even every compounding pharmacy is using the sub magna sublingual formulation for the drops. And yeah, swallowing. If you were swallowing, say even a hundred micrograms of semaglutide, it's probably gonna have zero effect on you because maybe one microgram [01:50:00] gets absorbed and it's pretty negligible.

You put it under your tongue though with the right vehicle, and then that's gonna increase the absorption by tenfold or greater. So then you get, say you dose a hundred micrograms, you're gonna get 10 micrograms minimum in the bloodstream, and then with 10 micrograms circulating, it may not sound like a ton, but again, semaglutide is very active, even if it low concentrations, because it binds very strongly to those GLP one receptors.

It's a GLP one receptor specific agonist. So, if you have a usual starting injection of a hundred and or sorry, 250 micrograms a week, but that gets in distributed over the week. So it's long acting. You're getting about 35 micrograms a day of release if you microdose. Even if you do say five micrograms daily, and even if you're only getting five micrograms a day [01:51:00] just to be conservative, you can get, they're about one seventh of the dose from what the body may see on the low end of an injection.

So it's, it's less, but it's not like homeopathy. Please don't take that the wrong way, homeopaths. But there is this study on sub Magna that shows you're gonna get higher plasma levels and more stable than the same amount given orally. And I think the more stable thing is really the key there as well.

It's well absorbed. It's getting into the bloodstream, it's reliable, reproducible, and sublingual s semaglutide is definitely, 10 times higher availability than oral tablets. So whoever asked that question is right. Swallowing micro doses is not gonna work, but we're not swallowing.

We're using sublingual plus the permeation enhancer, the sub magna to get around that low oral [01:52:00] bioavailability problem. And I think we've got enough data now from animal studies, compounding pharmacy research and the case studies to be confident that the micro doses are in fact resulting in pharmacologically active drug levels in the body.

Mrs. Madi Partovi: Okay. Thank you. 

Dr. Ryan Partovi, JD,NMD,MIFHI: And look, your sublingual circulation going right to the brain, most of the effects are on the brain. There's effects on the gut as well, but like you want mostly the brain effects on appetite. You're not really wanting a lot of the gut effects, so 

Mrs. Madi Partovi: yeah, so for those that are in the camp asking the question, how can a few micrograms do any anything?

But when you really see, like, take a look at the science behind absorption, it makes sense. Yeah. So I wanna move on to something important as safety and regulatory considerations. Yeah. Okay. 

Safety and Regulatory Considerations

Mrs. Madi Partovi: You mentioned off-label use is legal, but we talked [01:53:00] about the FDA making noise about compounded semaglutide.

So how can people get how can we ensure that our patients are getting this safely? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. So it is a hot topic and the first thing to remember is that off-label prescribing is. Very common. I think, roughly 20% or one in five prescriptions in the United States is for an off-label use. So there's nothing inherently legal or wrong about using in a FDA a approved drug in a different way than on its label as long as it's done, mindfully and based on evidence.

So that's really, frankly, that's how advances in, in, in yeah, the use of treatments works and how we ultimately personalize therapy. So, as we've said, semaglutide is FDA approved for type two diabetes for obesity through injection. [01:54:00] But the pharmacies that are compounding it have definitely been under a lot of scrutiny because big pharma does not like small pharma.

And there were some supply shortages of ozempic and wegovy. So the FDA allowed the compounding pharmacies to step in and fill demand under certain conditions. But then once big pharma supply improved, FDA started warning compounders to be careful. And, oh, we're concerned about quality control and the sourcing of the active ingredient.

And so, and then they said that the compounding with the salt form of semaglutide sodium is not allowed because it's not on the approved compounding list. But if you use. Semaglutide base, which is a slightly different form, maybe that's okay. So it's technical, but the point is, reputable pharmacies, like the ones that NMC works with natural med Choice, makes sure that the correct form and source the semaglutide is being used.

And obviously because it's being done compounded, ultra low [01:55:00] dose sublingual, it's not subject to any of the restrictions. FDA has recently come and put out PCCA has advised pharmacies to be cautious with marketing. They have to be careful not to say that it's just like WEGOVY or FDA a approved because it's not, we have to be transparent.

This is a compounded off-label repurposed product and, regulations are constantly evolving. But right now, we're making sure that regardless of what we do it's above board and we're gonna make sure we continue to do that. Doctor prescribes it, compounding pharmacy prepares it using the highest quality ingredients and the bases, and then it's shipped directly to the patient.

So, 

Mrs. Madi Partovi: yeah, so the key invitation here is work with a trustworthy provider and pharmacy. Okay. Don't go buy some glide drops off of Amazon or some [01:56:00] other sketchy online source without prescription. Okay. That's where you can get into trouble. Okay. Not to mention scams, I see plenty of stories on scams and the FDA warns that, there's so many unapproved unregulated products being sold directly to consumers claiming to be semaglutide and don't go down that route.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Exactly. So if you see a random website offering GLP one drops without a prescription run, run as fast as you can. On the other side of that coin going through, our practice or an actual telehealth practice in general means that there's gonna be where you actually see a doctor, there's a legit prescription, pharmacy compounds it, that's what you want.

Quality standardization and making sure that you use compounding for, NMC only uses compounding pharmacies that are using the PCCA sub magna base have good manufacturing practices. So we know that each bottle of a [01:57:00] sublingual semaglutide has what it says it has and will perform consistently.

So, that's. What it means to say that fulfillment sorry. Fulfillment is standardized and accessible. So in Natural Med Choice they have this program where basically you're able to access the medication in a safe, controlled way because the compounding process is tenderized and they're only using the compounding pharmacies that follow that process.

So every batch is the same concentration using the well-studied base and that it's accessible to be shipped to patients, in, in every state with clear instructions. 

Mrs. Madi Partovi: Okay, great. So you might be wondering how how you can get this, for the listeners who are thinking like, I might wanna [01:58:00] try this.

So for instance, a patient comes to Natural Med Choice wanting sublingual Microdose, semaglutide, what's that? They can't go to 

Dr. Ryan Partovi, JD,NMD,MIFHI: Natural Med Choice 

Mrs. Madi Partovi: to Aspen Wellness Institute. Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: They have to go to Aspen. They have to go to a practice. Natural Med Choice only works as a facilitator Correct.

To help the patients get connected to the compounding pharmacies that are offering the best prices. 

Mrs. Madi Partovi: Yes. So. Let me do this again. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Sure. 

Mrs. Madi Partovi: So if a patient comes through Aspen Wellness Institute, us wanting sublingual semaglutide so what steps are you going to go through? 

Patient-Centered Approach to Microdosing

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, so typically we're gonna start with like a group visit.

Actually no, before that we collect a lot of information, right? We collect medical history, the information about their goals, whether they're doing this for weight loss, autoimmune support, general wellness make sure we don't, they don't have any contraindications. Like, if you have a personal or family history of certain thyroid [01:59:00] cancer under uncontrolled hormonal issues.

There's some cautions that we would give or maybe we'd say don't do it. Certainly if you have active thyroid cancer, this is not for you. But if it is a good fit, we wanna prescribe the oral drops. So we then, oh, sorry. I should say then we do the group visit. We have a consultation where I answer any questions people have, and then we prescribe the oral semaglutide drops compound to the sub mag, sub magna base prescription goes to through NMC to one of their.

Partner compounding pharmacies, they pre prepare the solution. And this con the concentration, interestingly enough, can differ whether you're doing literal drops or if you're doing like a syringe to do more, more precise dosing. But suffice it to say it's all standardized so that you're gonna get clear, understandable instructions regardless of what you're, what you end up receiving.

And then the medication gets shipped through NM mc directly [02:00:00] to the patient. Your patient gets a bottle of a semaglutide solution. And again, either an oral syringe or a dropper for measuring the dose. And then we also provide a titration schedule with instructions. For example, start with 0.1 mil under the tongue three times a week or twice a week, or once a week.

Or hold it for two to five minutes, then sweat and swallow. Oh no, we always swallow. I don't know why I said spit. That was weird. And then you wanna basically gradually increase it every couple weeks until you start to see results. If on the other hand you're seeing results at the starting dose, stay there, right?

You don't have to leave your home. It's all done completely from home. It's all telehealth, mail order pharmacy coordinated, which is really great for accessibility. 

Mrs. Madi Partovi: Yeah, so essentially Aspen Wellness Institute offers this metabolic microdosing program in a really [02:01:00] holistic, smart, patient centered way.

You receive medical oversight, you receive the standardized compounding you receive convenient home delivery and you get the p the benefit of, the mental, emotional support and addressing that. And also the fitness aspect as well. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. And people have more questions, they can come on the next call.

We have the calls every month, so yeah. Yeah, we wanted to make sure, this is not some murky DIY thing, we wanna follow the latest data as it evolves and keep people up to date just like we did with Ivermectin and COVID. We want to give people the latest guidelines that we can with the foundation of our go start low and go slow model and incorporating the holistic support that Madi mentioned.

If if people are also involved in the wellness plan, we also can do some lab work and measure that, or they can go to their local primary care [02:02:00] physician and do lab work to monitor and that they have questions about anything. They can always bring that to the calls. 

Mrs. Madi Partovi: I I appreciate creating structured sound, patient-centered programs, and I for those of you, if this really lands for you out there as like you hear what we're saying and it sparks curiosity and it just wakes something up within you.

And, you hear that this is not just a fad, we're here to support you. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

Mrs. Madi Partovi: Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: And there's another one, one more thing I wanted to mention, which is that we have a nutraceutical partner. I'm not gonna say the name 'cause it may change soon, but I would say that there's also like a complimentary, supportive package of nutraceuticals that we recommend based on age and sex to help make sure there's no nutrient deficiencies, which can, obviously negatively impact the results that people will experience on [02:03:00] this kind of program that we recommend that they include along with the semaglutide, but it's the kind of thing we would do with all of our patients.

So

why are you laughing? 

Mrs. Madi Partovi: I just like, I had the song in my head. I have a cartoon in my head right now. Have you ever seen Voltron? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. I've seen like when they transform a bunch of different guys Yes. And the meccas and they all go into one big one. 

Mrs. Madi Partovi: And all those meccas are important. All the pieces.

Sure. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. That 

Mrs. Madi Partovi: make a whole, and yeah, people deserve that whole list. Sure. I think I've spoken in some other older episode about wholeness. Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Oh, I'm sure. In many of them, 

Mrs. Madi Partovi: yes. Okay. 

Addressing Mainstream Criticisms

Mrs. Madi Partovi: So I wanna address some mainstream cri criticisms and concerns. There is an article on medical news today, 

Dr. Ryan Partovi, JD,NMD,MIFHI: good old medical news today.[02:04:00] 

Yeah. Sorry. 

Mrs. Madi Partovi: And they divulge some pretty skeptical news claiming that, microing semaglutide opinion. 

Dr. Ryan Partovi, JD,NMD,MIFHI: I would say it was an opinion. Okay. 

Mrs. Madi Partovi: Thank you. Yes. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Opinion piece, 

Mrs. Madi Partovi: media opinion claiming that microdosing it, the stories or the the wor microdosing success is just purely anecdotal and not backed by any research.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. That sounds like a typical kind of big hospital, big pharma aligned to me. What do you think? 

Mrs. Madi Partovi: I wanna know what your response is to that. We need more evidence. Talk to your doctor. It's not gonna work. It's not approved. Yeah. I don't know, like a lot of squashing to me, 

Dr. Ryan Partovi, JD,NMD,MIFHI: I don't know that they say that.

I don't know that they say it's not gonna work or, but I think that on one hand it is true that it's not yet been validated by large scale clinical trials. But on the other hand, why would [02:05:00] they ever do those? Because, their goal Yeah. Is to sell medication, not, more medication.

Not less medication. 

Mrs. Madi Partovi: Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: So it's true that right now, and I think it's, 

Mrs. Madi Partovi: They already tried to squash that compounding pharmacies from, even entering into 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, of course. Yeah. So if you 

Mrs. Madi Partovi: listen and you follow the money, honey. 

The Science Behind Microdosing

Dr. Ryan Partovi, JD,NMD,MIFHI: Look, I'm a scientist at the end of the day, and I always say more studies are better than fewer.

I'd love to see formal trials of 0.1 milligram daily sublingual versus placebo in certain populations. Boom. Thank you. That may take years to happen. If ever, because there's again, no big pharma incentive to test low doses. There's just really, in fact, they have a disincentive.

It's like, oh, we would sell less of it if it turned out that we could get similar. A lot of patients got a similar result with a lower dose. So, in the meantime, we have to use our brains and think for [02:06:00] ourselves and as doctors make clinical decisions based on what we know of physiology and biochemistry and also what we see from small studies in patient experiences.

Mrs. Madi Partovi: As a consumer, that's what we're 

Dr. Ryan Partovi, JD,NMD,MIFHI: doing. 

Mrs. Madi Partovi: Yeah. And as a consumer, asking yourself the question like, am I being monetized? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. We all are to some degree, right? But I think that from the patient's perspective, I would say if somebody comes to me saying I can't tolerate 0.25 milligram injections, but I really want to get some help with my appetite or inflammation, I'm not gonna say too bad.

Come back when you're sicker. I'm gonna say, okay, let's see if there's a gentler approach that could work. It's off-label and experimental. Here's what we know and here what we don't. If you're on board with that, we can try it. Monitor your progress and see how it goes. So again, informed consent. And really, I think if you look at what's the intention behind this whole episode, it's informed consent, making [02:07:00] sure that people are.

Aware of the risks and potential benefits. And look, the good news is the risk of these micro doses are really quite low, much, much lower than the high doses. We're taking about a, we're talking about a drug, which is for, I would say the majority of people who take it pretty safe in terms of no long-term side effects.

Millions of people have taken the medications and we're using a much smaller amount, right? So the risk of serious adverse effects like pancreatitis. Pancreatitis is a real thing. I have a colleague who had a patient who had developed pancreatitis from taking a GLP one. It did resolve.

But I would just say that another reason for microdosing, right? This is definitely not somebody who microdosed. So, we would expect to see much many fewer of those side effects with the microdosing. But we just still have to stay vigilant. And I think people need to be in tune and in touch with their bodies.

And [02:08:00] if they notice something's strange, we need to do further investigation. So, yeah. 

Mrs. Madi Partovi: Yeah. I need to say something because it will now get me. And for those that you know are truly approaching. The macro dosing, the injection protocol with informed consent, and you've read the insert and you've done your research and you're willing to traverse, those intense side effects.

Then I invite you to take a look at that. Like why would you do that? That's all. I'll leave it open-ended and mysterious. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. I have stuff I could say about that, but I get You wanna leave it open ended, so 

Mrs. Madi Partovi: I know, like, I know it's just a small invitation. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Sure. 

Mrs. Madi Partovi: Okay. So you made an important distinction.

Okay. So the lack of a large trial doesn't mean that there is no benefit. It just means that's, it's unproven in [02:09:00] literature. And meanwhile there are real people. 

Dr. Ryan Partovi, JD,NMD,MIFHI: By the way, about 60% of all medical treatments used by conventional medicine are unproven in the literature. Just FYI only about 40% are actually evidence-based, like, like I shouldn't say evidence-based, I would say.

'cause that's jargony, I would say have been proven effective. 

Yeah. 

Mrs. Madi Partovi: Yes. Meanwhile, real people are getting real benefits, by trying it. No. 

Dr. Ryan Partovi, JD,NMD,MIFHI: And that, by the way, the statistic I just said comes from Cochrane which is the gold standard in meta-analysis, which is, looking at the big picture of medicine.

Mrs. Madi Partovi: Yeah. And, coming from a philosophical angle sometimes the guidelines that the FDA, approves to co like aims to cover they only cover a broad population and they ensure that no one is undertreated or put at risk. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah.

Mrs. Madi Partovi: It's great for public health and liability, but it can mean that they're not [02:10:00] optimized for certain individual individuals.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. I think when it comes to drug trials, they're usually, there's like this weird tension between wanting to make sure no one is undertreated or put at risk. And so they're gonna pick a dose where oftentimes, it's gonna work for say, 95 plus percent of people, or at least the majority, and then yet we're not gonna have anybody die from it, right?

So that's the range that they're looking at. And the problem is that humans are so different. On the outside, as my biochemistry professor said. If you look at how different we are on the outside, then you multiply that times 10. That's how different we are on the inside. So I think given that it just doesn't make, in make sense that people need to be, we all have different GLP one sensitivity [02:11:00] and excuse me.

There's, I'm sure many different types of GLP one receptors out there and different, genetic polymorphisms that reg, that control the function of those receptors and et cetera, et cetera, et cetera. 

Mrs. Madi Partovi: Yeah. 

Personalized Medicine and Patient Optimization

Mrs. Madi Partovi: So I just, I like the sound of patient optimization, customizing therapy to the individual.

Yeah. It's not about one size fits all approach. And liability minimization and standardized care, or should I say substandard care? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Look, FDA is just trying to see, does this work to lose weight? Yes, we know it does at the big doses, but the guidelines are gonna be built on averages and making sure you get e efficacy in the majority.

But that also means you're gonna have side effects for the very substantial minority of people that maybe can't tolerate those average doses. So. [02:12:00] FDA tends to err on the side of use A dose we know works for weight loss in a clinical trial, but that dose could be more than what a particular patient me needs sometimes by an order of magnitude.

And it may also give them a lot of side effects that they would avoid if they use a lower dose and get a similar benefit. So one of the benefit of going to a doctor is we can adjust dosing. We can, the word medicine is actually the original meaning of the word medicine is the art of healing.

So if you're seeing a doctor, that's really what they should be practicing is the art of healing not 

Mrs. Madi Partovi: pharmaceutical 

Dr. Ryan Partovi, JD,NMD,MIFHI: being heal healthcare provider, right? Like we talked about earlier, 

Mrs. Madi Partovi: pharmaceutical drug salesman. 

Dr. Ryan Partovi, JD,NMD,MIFHI: So we've talked about the lowest effective dose, and there's really no need to just keep pushing the dose up for no reason.

And a lot of people have been told, oh no, you gotta keep ramping it up. But no, if you're happy at a dose, you're losing a [02:13:00] pound a week, you're feeling good, you do not have to increase your dose. In our practice, we stay at the lowest effective dose because this is ultimately about not just hitting the number right, that you're looking for on the scale, but really about.

The holistic picture, right? You and where you are in your health journey and what it's gonna best serve you. And I think that the microdosing kind of fits right along with that ethos, because what it's saying ultimately is that maybe even lower doses than we'd normally consider might still provide benefit.

So let's carefully monitor, make sure that it's, doing something but also not causing too many side effects and just adjust the dose as needed. And look, if it's not effective enough, we can increase the dose, right? It's not a big deal. The point is to find the sweet spot where you're getting benefits with basically no downsides.

[02:14:00] And, frankly, I'm, I hope that's empowering to our patients. I know that they often feel like they have, the point is to put the control, I should say, in the hands of the patients to a great degree. We're here to consult and provide advice, but they're helping to make micro decisions along the way to help guide the treatment process specifically the titration based on their comfort level and, progress Yeah.

And of their symptoms or losing weight or side effects, et cetera. So, 

Mrs. Madi Partovi: okay. I really love that. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

Mrs. Madi Partovi: I wanna really drive home. I wanna address one more criticism. What would you say to somebody that tells you that my sing semaglutide is just unproven, it's all placebo and it's not sustainable? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah.

Look, I would say that even if [02:15:00] your goal is not a large amount of weight loss, patients on microdosing do often experience tangible changes, less hunger, better blood sugar readings that are physiologically explainable by the drug's action. So it's not just placebo. Some people may worry about, okay, what about are you just delaying the inevitable need for a higher dose?

But again, for some people that higher dose might never come if their goals are met with these micro dosing levels. Right? 

Mrs. Madi Partovi: Yeah. 

Dr. Ryan Partovi, JD,NMD,MIFHI: So, yeah, definitely some patients may eventually decide to escalate. We can, we can do that sublingually or we can, patients can switch to the injections, which we again, typically don't do unless the patient's a type two diabetic.

But, and there's a lot of different reasons why they may wanna escalate. Maybe they play plateauing, not seeing the weight loss they'd expect, or the dose that they're at. And then of [02:16:00] course we can also reformulate the sublingual as well. There's really no need to switch to injections. Microdosing, in other words, microdosing doesn't burn any bridges.

You can always, go back and forth with the macro dosing. But I would say that for a lot of people, microdosing is gonna be a good long-term maintenance strategy. If you say lost of a lot of weight under the macro dosing, microdosing is a great way to maintain the weight the weight loss.

So yeah, it's very common in medicine to use, start off strong and then you go to a lower dose for maintenance. It's, that's true in psychiatric care. It's true in in hormones. And, these are peptide hormones. So, at the end of the day the level of efficacy as well as sustain sustainability of the GLP one approach is gonna be based on the patient's ongoing [02:17:00] lifestyle, diet and lifestyle choices.

And, we always want to combine the GLP one therapy with healthy diet and exercise. Hopefully blood type specific diet, a odomo diet, swami diet would be ideal. And that doesn't change with microdosing. In fact, I think it becomes in even more important because when you have that holistic plan, it actually empowers the response to stay as gentle as possible.

So in other words, you can keep that GLP one dose as low as possible, so you have that gentle response and you're not having to risk the side effects and you're not having to ramp up the dose. So you can really pay attention to, what your body's telling you about food and your core needs and help you work on your habits.

So, 

Mrs. Madi Partovi: yeah. I have another [02:18:00] picture in my mind. It's kinda like, using an electric bike, right? You're still pedaling, like your feet are still moving round and round, but you're getting a little bit of help up the hills. And you're not having to ride a motorbike, more prone to accidents and Yeah.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. I would say maybe one that, that is like you said, assisting you on the way of pills. That makes sense. Yeah, I like that. Like microing, semaglutide is like an e-bike for your metabolism. You're still doing the work, but it smooths the ride 

Mrs. Madi Partovi: gently healing your metabolic pathways. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah.

I don't know, it's whatever.

Mrs. Madi Partovi: You didn't like that? Me? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. I don't know about the healing of the, okay. Okay. 

Mrs. Madi Partovi: Okay. It 

Dr. Ryan Partovi, JD,NMD,MIFHI: is, it's a little too, I know. Conceptual for me. Yes.

Mrs. Madi Partovi: Okay. So let's 

Dr. Ryan Partovi, JD,NMD,MIFHI: gonna sum up, 

Mrs. Madi Partovi: sum up. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah, 

Mrs. Madi Partovi: sum up. [02:19:00] Okay. So, GLP one receptor agonists like semaglutide, they're powerful hormone mimicking drugs that help control appetite, blood sugar, and weight. The standard use conventional Rockefeller use is a high dose weekly injections for big metabolic, I don't wanna say improvements, changes weight loss.

Marker dosing is an emerging off-label approach where we use tiny doses, often sub lingly under the tongue to get some benefits with minimal side effects, right? Essentially aiming for the lowest effective dose. So we explored today how sublingual delivery, like under the tongue, could make those tiny doses effective by bypassing the gut and using special formulations like sub Magna to enhance absorption.

We learned that sublingual [02:20:00] semaglutide has been shown in animal studies and pharmacy data to absorb more quickly and more consistently than traditional oral dosing. And sometimes we achieve up to it's been shown to achieve up to 10% absorption versus 1% if swallowed. Okay. So that means a little can go a longer way.

It reaches peak levels fast within 30 minutes and has a smoother blood level profile, which likely reduces side effects. Spikes. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. 

Mrs. Madi Partovi: Right? 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. Correct. All, all good. 

Holistic Health Benefits of Microdosing

Dr. Ryan Partovi, JD,NMD,MIFHI: So, we talked about how microdosing is being used not just for weight, but for holistic health benefits. We talked about inflammation, helping people with autoimmune conditions, supporting brain health, improving metabolic markers, aligning with longevity concerns.

It's not necessarily about the big, huge, really super fast, dramatic weight loss that leaves you with like a big flap of skin. You're gonna [02:21:00] lose, at least to stop gaining weight and hopefully start to lose a little bit over time. As we increase the dose. Maybe you don't even need that, but it's about gentle optimization and your comfort.

And by using the micro doses. People typically don't have side effects. Little to no nausea or GI distress, which is really a big contrast with the standard dosing and all those horror stories that Madi read out at the beginning of the episode. It can be a way for people who are very sensitive or have chronic illness like mold illness, chronic inflammatory response syndrome, other biotoxin illness, fibromyalgia to access the benefits of the GL one GLP one therapy without overwhelming their system.

So we've seen and referenced some anecdotes like reduced joint pain, fatigue and low dose semaglutide sublingual users, and we've talked about some key [02:22:00] questions about mold and autoimmune illness, anti-inflammatory metabolic effects. We've talked about how oral avail bioavailability doesn't apply here because we're not relying on stomach absorption.

We're doing sublingual, which is tenfold better with the vehicle that we're using. 

Legalities and Off-Label Use

Dr. Ryan Partovi, JD,NMD,MIFHI: We talked about, how tirzepatide is different and when it should be used, and we also talked about the legalities around off-label microdosing and. How common that is, or off-label is in general.

And more specifically that the semaglutide that we're using in the MI metabolic microdosing program is compounded in a US-based compounding pharmacy with very clear known quality. We follow our patients and, whether the FDA approves it or not really doesn't matter because we start with conformed informed [02:23:00] consent.

So it's really a, it's a new way to use a medication that was developed for diabetes that I think it's pretty exciting what we're able to do to help in many different issues, including the obesity situation. So, yeah. Yeah. Our fundamental approach really is making sure it's safe for you, not just assuming that the typical protocol is gonna fit everybody.

Mrs. Madi Partovi: Yeah. We also addressed a mainstream skepticism and that there are no large studies like proving microdosing. So one should be cautious and, not see it as a magic bullet or guaranteed. But I do wanna say that microdosing, semaglutide has earned a spot in our practice, and that says a lot.

'cause we don't just, willy nilly. Here's a drug that's gonna save the day. There's just a lot that we go through morally [02:24:00] for one. Yeah. That, that we shared about on this episode.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. And 

Mrs. Madi Partovi: so we're doing this responsibly. Okay. And I really just like the idea of off-label, low dose, non-mainstream. It just, it's such an empowering path, when done responsibly. That's what I really want everybody to get. 

Dr. Ryan Partovi, JD,NMD,MIFHI: Yeah. No, said. And look, I wanna emphasize the done responsibly, because that always involves a knowledgeable healthcare practitioner.

This is not something you want to tinker with entirely on your own. Importing drugs from the Lord knows where and trying to do DIY we, you want to calibrate dosing, touch base with the doctor watch your lab work either through the wellness plan or through your local primary. Make sure [02:25:00] there's no interactions with other medications.

For example, if somebody's already on insulin or some other diabetes meds, we need to adjust those carefully to avoid low blood sugar. But you're probably not gonna see, low blood sugar by itself. You just microdosing GLP one. It may be just like a combination, for example.

So, and for those who are interested, asthma Wellness Institute, our practice offers a structured sublingual semaglutide microdosing program, metabolic microdosing. It's designed to be safe and convenient. And look, we standardize the fulfillment process by working with NMC and trusted compounding pharmacies to get the formulation right, the dosing right, that's consistent and backed by the compounding science with the sub magna base so that patients aren't getting random concentrations.

And look, it's accessible, right? You don't have to go anywhere, it's just all delivered straight to you through telehealth. We can work with [02:26:00] patients, from our practice in California. We can work with patients all over the country and and get the medication delivered to your doorstep.

So, 

Mrs. Madi Partovi: yeah, and if you'd like to learn more or you feel that this might be right for you reach out to us. Our information is in the show notes. We'd be happy to answer any questions you have and to see if you're a great, a fit and match a great candidate for this pilot program. And you are unique. Everybody is unique and we're not telling everybody that, every single listener needs to microdose semaglutide, and we can support you with a powerful discernment about that. Okay. 

Conclusion and Future of Medicine

Mrs. Madi Partovi: I hope that you've learned something new and intriguing about medications that can be used in innovative ways.

Dr. Ryan Partovi, JD,NMD,MIFHI: Yep. I enjoy doing the deep dive. I think that, anytime we're getting in the world [02:27:00] of the latest science, like new drug delivery systems or, for that matter, nutraceutical delivery systems, plus we're looking at individualized care, tailoring the dose using sublingual versus injections, all that kind of stuff.

It's, this is like the future of medicine now, which is really my jam, and it's moving beyond the one size fits all paradigm and into what works for the patient, truly individualized care. So, 

Mrs. Madi Partovi: yeah. So I really enjoy and I love the process of rewriting some of these rules with you and just continuing to share with our community, like where we stand when it comes to intentional, comprehensive healthcare.

Yeah. Yeah. And what we share on our podcast is creating the consensus and, creating that ripple effect of knowledge and of empowerment, in healthcare. Or [02:28:00] empowering the individual. 

Dr. Ryan Partovi, JD,NMD,MIFHI: It's a great place to end it. I think that I don't have anything else. I, we've I think we've exhausted the topic of sublingual microdosing of GLP one agonists, hopefully giving you guys plenty to chew on no pun intended, given the sublingual theme.

But yeah. Thanks for joining us. 

Mrs. Madi Partovi: Yes. Thank you for joining us and for our YouTube subscribers. Thank you for 12,000 plus subscribers. We just, we appreciate you and we're grateful for you. I 

Dr. Ryan Partovi, JD,NMD,MIFHI: Go ahead. 

Mrs. Madi Partovi: I am Mrs. Madi Partovi. 

Dr. Ryan Partovi, JD,NMD,MIFHI: And I'm Dr. Ryan Partovi. Be well