Why the Same GLP-1 Dose Feels Worse Next Week w/ Dr. Ian Ellis

Why can the same GLP-1 shot feel fine one week and make eating or side effects so much worse the next? In this episode, Ana talks with Dr. Ian Justl Ellis about the difference between the standard doses of GLP-1 and the medicine still in your body, why the standard four-week ladder keeps that level climbing, and how to think about a dose you can actually live on, including maintenance and travel.

**IN THIS EPISODE**
- Why a dose and your medication level are not the same thing
- How a long half-life makes week two on the same dose feel stronger
- Why the standard every-four-weeks ladder keeps restarting the climb
- What a livable sweet spot feels like: some hunger, enough protein, no side effects
- Why a plateau after appetite is controlled may not mean “go up”
- How changing frequency, not just milligrams, can flatten end-of-week hunger
- Maintenance, travel, and cycling on and off without flying blind
- Why so many people quit around week five

**ABOUT THE GUEST**
Dr. Ian Ellis is a physician and the founder of Voafit, a platform focused on individualized GLP-1 care and precision dosing. Drawing from both his clinical background and his own personal experience with obesity and Ozempic, Dr. Ellis developed an approach centered on bloodstream levels rather than dose alone to help reduce side effects, improve adherence, and create better long-term outcomes for patients. He is passionate about making obesity treatment more personalized, effective, and humane.

**CONNECT WITH DR. ELLIS**
Voafit: https://voafit.com
MyLevel: https://voafit.com/mylevel
Social: @voafitmd

**SPONSORS**
Calocurb — a plant-based supplement designed to support your body’s own GLP-1 response and appetite control. https://calocurb.com — use code ANA10 for 10% off.

Johnson Fitness and Wellness — strength equipment and expert help for a home setup that actually fits your space and budget. https://www.johnsonfitness.com — use code GLP1Hub5 for an exclusive listener offer.

**CHAPTERS**
00:00 Why the same dose can feel different
01:37 Meet Dr. Ian Ellis
03:08 Why the standard 4-week ladder exists
05:27 Dose vs medication level
06:23 Half-life: why week two is stronger
10:01 Ian’s first weeks on semaglutide
13:34 Fixed pens vs adjustable dosing
15:23 What the sweet spot actually feels like
17:21 Clinic results: lower dose, zero dropouts
18:59 When a fraction of the starting dose is enough
22:27 Using an app like a thermostat for appetite
24:07 Why end-of-week hunger isn’t a reason to go up
25:47 How to adjust safely under a prescription cap
30:49 Maintenance, travel, and cycling on and off
39:00 Why so many people quit at week five

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*The content of this show is for informational purposes only and does not constitute medical advice. The goal of this show is to provide various points of view about GLP-1 Medications. The personal and professional opinion of the guests and their content does not necessarily reflect the opinion of Ana Reisdorf or GLP-1 Hub.

Transcript

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SPEAKER_00 0:00

That being said, here's the key. Precision medicine, small, frequent adjustments to stay in a sweet spot. Okay. That can never be clinician dependent. Because what doctor has the ability to manage micro adjustments on a weekly or bi-weekly basis for a thousand patients?

SPEAKER_01 0:21

None.

SPEAKER_00 0:22

We have to find a way to empower patients who safely make adjustments under supervision and within boundaries to be able to adjust their own experience.

SPEAKER_03 0:33

Have you ever taken the exact same GLP 1 dose two weeks in a row, but then had a completely different experience? You may feel great the first week, then struggle with nausea, food aversion, or low energy after the next dose. According to today's guest, the difference may come down to what is still in your body when you take that next shot. I'm Anna Reisdorf registered dietitian and GLP1 user, and this is the GLP1 Hub Podcast. And today I'm speaking with Dr. Ian Ellis, a board certified physician and founder of Voafit, about why a dose and your actual medication level are not the same thing. We discuss how GLP1s build up over time, why the standard step up schedule can move some people past their personal sweet spot, and what it could look like to individualize treatment while staying within the prescribed limits and under medical supervision. We also talk about side effects, plateaus, maintenance, travel, and finding enough appetite control without losing the ability to nourish your body and live your life. Now let's get into this conversation. Welcome to the Jill IP1Hub podcast. I'm very excited about today's guest. You may have heard him on the On the Pen podcast, if you listen over there with Dave. It's Dr. Ellis. He is going to talk today about a different dosing strategy. Did you want to introduce yourself and tell the people what you do?

SPEAKER_00 1:52

Yeah, thank you so much, Anna. It's such a true privilege to uh be invited on the podcast and hopefully help more people succeed uh on these incredibly important but also difficult at times to take and manage medicines. So, by way of a brief introduction, you know, I run a company called Voafit. We're a concierge telemedicine practice based in Dallas Fort Worth. Uh, we're licensed in, I think, 48 states now, chasing those final two state licenses, but we can take care of people across most of the United States now. And our focus, although we do a lot of things, is mostly precision dosing of GLP1 medications and helping people succeed on those medicines. By way of background, I'm a board certified MD. I worked full-time in the emergency department for 10 years. With the advent of GLP1s, it became very obvious to me that these were A, the future, B, some of the most important medicines that have ever been invented, and C require very significant care to make them successful. And so I retired from the ER Open Mound Clinic to share some lessons I learned along the way from my own GLP1 experience, as well as caring now for many, many hundreds of patients, and have developed a novel method of dosing these things that allows for a lot more precision than the typical standard dosing protocol.

SPEAKER_03 3:08

So we all have heard you get on a GLP one, you go up every four weeks until you reach the max dose. And that's been seen, I don't know, as the holy grail. And there has been some understanding more and more over the years that maybe that's not the best approach, but that's what they used in the studies, and that's what the doctors are just doing. That's the way you use the medication. So tell us a little bit more about that and why they think the standard thinking is like that.

SPEAKER_00 3:35

Yeah. So the original landmark trials that proved efficacy for these medicines, I would say they were not just well designed, they were almost brilliantly designed. Okay. Because the way the standard dosing ladder causes medication to build up in your system. In the study, they had, you know, 20 to 24 weeks of consistently increasing drug levels and were able to see on a population level what was the efficacy compared over time. Okay. And what they found, predictably enough, is that higher doses of medicine result in, on average, higher amounts of weight loss. And so they transposed this study protocol into the standard of care. Okay. The problem is they studied a particular population that doesn't apply to everyone. And they also studied it in a particular way, okay, that also doesn't apply to a lot of people just out in the world that are trying to lose weight. And so we have great population data for efficacy, but the study never asked the question and didn't have the means to answer this escalating ladder of drug levels that are efficacious to some degree to a population. Which drug level, or another way of saying it, is degree of medicine exposure works for an individual, for you, for your own body, this one person, okay? It makes intuitive sense that if you have a ladder with 24 rungs, okay, of different escalating drug levels, there's probably one of those rungs that works best for you, okay? Which one?

SPEAKER_03 5:09

Right. So I see a question come out like that a lot. Which dose worked best for you? And people want to know, and of course it doesn't apply. What worked best for you doesn't work best for me. So it seems like an irrelevant question, but there seems to be this idea that if you could just find that magic dose, that all your problems would be.

SPEAKER_00 5:28

So you're half there, okay? There's something to it for sure. Okay, there is a dose that works for most people. Okay. There's a couple problems, okay, and I'll try to describe this in a way that's really understandable. Okay. We need to understand the difference between a dose, which is a single input, you take it right then, and a medicine level.

SPEAKER_03 5:49

Hmm. Okay.

SPEAKER_00 5:50

A medicine level is the total amount of medicine that is active in your body. Okay. How much medicine is in there? That's what your body cares about. Okay. How much medicine is actively working? A dose adds medicine to that amount that's in your body. Okay. But here's the trick. This whole thing turns on. The half-life for GLP1 medicines is very long. Now, what is a half-life? A half-life is just how long it takes for your body to use up half of the medicine that you put in there. Okay. For semaglutide, it's about a week. For truseptide, it's a little over five days. Okay. What does that mean? Okay. Let's say I'm going to use an even round number as an example. Let's take, let's say you take one milligram one of a drug with a week-long half-life. Well, what is your medication level after that first dose? It's around one. You started with zero, you absorb that medicine, and now you have a drug level of or a peak level of close to one. It's not perfect. There's some math involved, but for the purposes of example, okay? You fast forward a week.

unknown 6:54

Okay?

SPEAKER_00 6:54

Sunday to Sunday. The next Sunday, your doc says, okay, it's time for your next dose. You are gonna stay at the same dose. So you're gonna take one again. Okay. You might think reasonably enough, I'm gonna take the same dose, I'm gonna feel the same way. All right. But how much is left in your body at a week? How much is left over at the end of that first week? What's the answer?

SPEAKER_03 7:15

It's a half-life, so it'd be 0.5.

SPEAKER_00 7:17

Exactly. So there's 0.5 left. You're not starting from zero now from that dose. You're adding one more milligram to that half milligram. Well, now your drug exposure, your level is 50% higher that next week. Well, that results in a different experience. Your body isn't responding to the same dose. It's saying, there's more medicine in me than last week. Okay. Well, what happens the week after that? Now there's 0.75 left, and you add another one. Now you're at 1.75. And so you can see that you don't stabilize at a consistent bodily experience very quickly. In fact, it takes about five half-lives to or five doses, excuse me, to stabilize. Okay. So what what does that mean in plain English? That means in that first month where you stay at the same dose, you have four distinct medication levels, ergo four distinct medication experiences. What if your best week was week two? Wouldn't you want to stay there? Right. Why would you increase? Well, you increase because the medicine and standard dosing makes increasing inevitable. Okay. You're forced to go up, even when you're at the same dose. That's kind of weird, right? You stay at the same dose, but you still have a stronger medication experience. Right. Well, what happens on week five? Just as you tend to stabilize, what does the standard protocol tell you to do? Then go up. Go up. And it starts the process all over again. Which again, from zero to your first, you know, dose of that highest level, right? Let's say 15 milligrams of trisepatide. If you follow the standard protocol exactly, you will have 20 unique individual, different medication experiences all the way along. Okay. Again, we've most of us have had the experience of, man, this dose was great. My food noise was down. I had good energy. I wasn't sick. This is my sweet spot. And you go, oh God, thank, thank goodness I found it, right? And you take the same dose again, and the next week doesn't feel so good, right? And it's like, what the heck? Like, and and then you then you adjust your dose because you try to chase it. Yes. But then it takes five weeks for that dose to settle into maintenance. And so we end up just fighting, and it's almost like, you know, you're playing pin the tail on the donkey in the dark. Right? We're all looking for that holy grail GLP one experience where you still get hungry a little bit, at least sometimes, you can get enough protein, you can get your plants in, you still have good energy, you're not having side effects. Well, it turns out the standard protocol makes it almost impossible to find. Okay. My own personal story with this. This is why I began this journey of making basically my whole life, helping people figure out how to do this, is because I've had my own lifelong challenge with obesity, overweight, and excessive appetite. I was introduced to semaglutide in 2021. I took my first dose, 0.25 milligrams, just like everybody else, because I didn't know a damn thing about this at the time. Okay. My first week, in fact, the day after my dose, it was like the best day of my life. It was like the doors of heaven opened up and shone down upon me because for the first time in my life, I wasn't fighting my appetite, tooth and nail. I wasn't battling with myself to put down, you know, this piece of food and I'd eat two or three or five and spend three hours in the treadmill making it up. Okay. I just put it away and I went on with my life. And I was like, I guess this is what it's like to feel full, you know, but I still felt good. I didn't have side effects. I still had good energy. I could still eat enough. Okay. Well, week two, same dose. I didn't feel so good. I had some GI side effects. I had a little bit of food aversion the day after my second dose from like, I really don't feel like I can eat at all. And when I would try, I would get a little sick. Even worse on week three, even worse on week four. And week five, like a good little patient, I doubled my dose and then I got really sick. And I never felt good again after that. All the way down, I lost 30 pounds. It was the easiest, you know, weight I'd ever dropped, but I felt terrible the whole time. And in the end, I lost a whole lot of muscle mass. I lost a ton of strength, and I ended up a smaller, weaker, sicker version of myself. Okay. Well, it was on the on one hand so freeing to not have to battle my appetite, but on the other hand, totally unacceptable. Coming from someone who has a background in bodybuilding, personal training, nutrition, I knew this is also not okay. It's not okay for me to never eat. It's not okay for me to not get enough protein. It's not okay for me to not exercise because I just don't have the energy. And when I do, I feel dizzy and sick, right? And I knew there had to be a middle ground. How can and and I remember the epiphany I had was remembering my first week and going, why did it change? Why was my second week different than my first? Why was why did I get so sick on week five, right? And turns out the answer is just math. It's because my medication levels were continuously building up and I was never afforded the chance to stay right where I wanted to be.

SPEAKER_03 12:34

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SPEAKER_00 13:45

Sure does.

SPEAKER_03 13:46

How do you figure out your dose if you have a five milligram?

SPEAKER_00 13:52

It's a pickle, isn't it?

SPEAKER_03 13:53

Yeah.

SPEAKER_00 13:54

So the short answer is those single fixed doses make it impossible for individuals to actually find the best drug level and stay there. Those doses were developed as a result of the study protocol and for convenience. Okay. Like I said, they have nothing to do with an individual patient. Okay. So to do precision dosing of GLP1s, you absolutely have to either use a multi-dose compounded vial or get a big vial and split it up. Or uh you can use a quick pen. I'm you know, the quick pens that they've released recently for just trzepatide, you can kind of dial a dose, and there's some pens with Wagovi and things like that where you can adjust your dosing as well. But suffice to say, you have to be able to control the amount. Okay, that's a prerequisite. Uh you have to be able to know what is, and this is the the essential question. Okay. In fact, I'll I'll form it as two questions. What is the level of medication that makes me feel my best? What is that? Of those, you know, steps along the way, which one do I want to be at? You have to be able to find that answer.

SPEAKER_04 15:01

Okay.

SPEAKER_00 15:02

Number two, what is the dose to hit that goal? How much do I take right now, at this moment in time, to hit that level? So you have to know what it is to be able to find it. And you have to know what's what's the dose to hit that level when you take your medicine.

SPEAKER_02 15:18

So how do you find it? Is that a subjective measure or is that an objective measure?

SPEAKER_00 15:23

Yeah. So it's it is by definition subjective.

SPEAKER_02 15:26

Okay.

SPEAKER_00 15:27

Because subjective, no, it's an objective measurement or calculation. You get an actual number, but what determines the best level, that's based on how you feel. Right. Okay. What do I describe as the sweet spot to most people? I already said it once here. You still get hungry sometimes. When you eat, you get full fast, you can still get enough protein, you can still get enough nutrition, and you're not having side effects. Okay. That's the medicine doing its job. That's all it is supposed to do, right? Once you've found that sweet spot, if you're plateaued, okay, it's not the medicine's fault. There's something else going on. Is it hormones? Because you've already controlled your appetite.

SPEAKER_02 16:05

Right.

SPEAKER_00 16:05

That's what these medicines are for. Okay. So if you're plateaued, the answer is not to crank it up to 11 so you never eat again, because that comes with huge detriments and downsides, right? The answer is dig deeper, figure out what's going on. Is it my exercise routine? Is it the diet quality, which the medicine has nothing to say about, right? Is it my hormones? Is there something else underlying? Okay. The answer is not just keep pounding that GLP1 button. Because once you reach satisfactory appetite suppression, the medicine has done its job. That's all it can do. Okay. Begs the question. How do you find that level? Yeah. How do you calculate that dose? Well, it turns out it's very complicated, which is why nobody does it. Okay. It's a lot of math. Okay. Because you need to know, you need to know every dose you've ever taken, when you took it, how much of that was absorbed, how much of that stacked on the last one to calculate your real time. This is where I'm at right now. Okay. And then you need to be calculated this is where I want to be, this is where I am. And what's the difference? Taking into account bioavailability, how much is absorbed, all those kind of things. Well, that sounds pretty damn overwhelming.

SPEAKER_03 17:13

Yeah.

SPEAKER_00 17:14

Okay. And it is overwhelming. And that's why doctors don't do it. Okay. I'm a crazy person. So I did it for a year for myself, for all of my clinic's patients. We got an initial cohort, about 114 patients, manually calculating every dose, every patient for a whole year. Couldn't you AI?

SPEAKER_03 17:34

I feel like AI would be really good at that.

SPEAKER_00 17:36

This is a little before AI was like really a thing. Okay. It's certainly not to the, you know, this was there was a lot of Google Sheets and calculators involved. Okay. Well, it wasn't scalable. Nobody could do that at scale with hundreds and hundreds of patients. But what it did do is prove that it works. Because here was the outcome for those 114 patients, and I include myself in that patient cohort. We lost weight faster than the trials would have predicted. Okay. Time matched to the original trials and the standard dosing ladder. And we took an average of 50% of the dose. Some people took a tenth of the standard dose and still lost weight faster than the trials would have predicted. Okay, we'll talk about how that's even possible in a moment. But here's the kicker. You know how many patients dropped out due to side effects?

SPEAKER_03 18:24

I would love to know.

SPEAKER_00 18:25

The answer is zero. Not a single person quit because of side effects. Why? Because we didn't tolerate them. We said if you're having side effects that were significant, okay, turn it down. Adjust your dose. Find that sweet spot. Even if it's a moving target, let's do the work on a dose-to-dose basis. If you if you couldn't eat last week, we're not going to tell you to tough it out and force your body to adapt. We're certainly not going to increase your dose just because a schedule says to do so. We're going to decrease and find that sweet spot. Okay. Well, I'll give a couple real-time examples. Okay. Okay. Uh a young lady, I can use her name at permission. Her name is Mary Alice. Okay. Well, Mary Alice, she came to me, a very typical patient, had 25 pounds to lose, no significant medical comorbidities, not someone that would have even qualified for treatment in the original trials. Okay. But someone who was distressed by her body and was overweight. Okay. But she came to me and said, you know, I uh I'm a little scared because I've heard of side effects with these medicines. I'm really sensitive to medicine. I'm the type that takes NyQuil and I'm I sleep for two days. So like be careful with me. And I said, This is right up my alley. This is absolutely how we do this. So let's start you on a third of the starting dose. Okay. So less than a milligram of trosepatide. Well, she wasn't lying. She was really sensitive. And turns out she got really sick. Nausea, vomiting, diarrhea, couldn't leave the bathroom for like three or four days. Okay. On less than a third of the starting dose. So what would a primary care doctor have done in that situation?

SPEAKER_02 19:54

Then like this is a good thing.

SPEAKER_00 19:56

First of all, they probably would have started her at 2.5. And dear Lord in heaven, what would have happened to her then? Okay. She would have been a one-dose quit patient, right? Even if she managed to tough it out and said, man, doc, this is really important to me. What would they do? Well, let's stay at the same dose. But jokes on her because you stay at the same dose and you still increase. Week two, right? What did we do? We calculated her level that she reached from that first dose. And we said, no matter what this number is, we're going lower because it's obviously too much.

SPEAKER_06 20:28

Right. Right.

SPEAKER_00 20:29

Well, we calculated the dose necessary to get her to about half of that initial level, which because there were still some left in her, was only a fraction, right? Of that first dose. Well, it turns out it was a tenth of the starting dose, was her second dose. All right. That's almost homeopathy, right? There's nothing in the syringe. You know, let's inject this thing that we can't even see. Okay. Well, wouldn't you know? She didn't get sick the second week. Her weight loss stabilized, and she went on to lose about a pound and a half a week every week, all the way until she reached her goal and never had another bad day. Wow. Okay. Well, what was her outcome? She lost the 25 pounds. And do you know that she never even reached the starting dose for terzepatide? Not one time. Okay. Well, that is a person. The trial has nothing to say to, right? It would kick the crap out of her, the first dose, and then she'd quit. Yeah. That'd be the end of it. As it is, if you can calculate the level, figure out what works for her, and adjust the dosing to keep her there, she can have this unbelievably important outcome to her because she exited into maintenance on a fractional dose of trazepatide, having reached her goal, no longer fighting her appetite, and feeling great.

SPEAKER_03 21:41

Right. And I've heard people say, like, I cannot take this medication at all, right? Because they are following the protocol and that's unfortunate because they need it.

SPEAKER_00 21:50

Right. Exactly.

SPEAKER_03 21:51

So it's like, what's you know, there's no solution for them except, you know, what you're what you're suggesting. But to to date, there's really nothing. The doctor will just be like, Sorry.

SPEAKER_00 22:00

Yeah. Or what would happen if for someone who's being thoughtful is they say, well, let's try a little bit lower. Let's take a half dose. Maybe we'll even think about split dosing or finding some other way to adjust the medicine. Okay. But they're still flying blind. They're still making adjustments that take weeks to set in. Okay. And they still don't know how much is in her right now, how much is this dose adjustment going to affect what's going on? So you have to find visibility into those levels to be able to do this intelligently. Okay. Well, what's the conclusion here? We needed some technology to do this for us because manually calculating this is not feasible. It's not scalable. Doctors can't do it. Patients can't do it either. Okay. But our clinic cohort proved it really works. Right sizing the dose for the individual patient results in greater weight loss with fewer plateaus on a much lower dose of medicine with many fewer side effects. Okay. So we built an app, just like everyone else these days, right? There's an app for that. So we built an app that has a very simple interface. As long as you log your doses, you tell it when you took your doses and what you took. It calculates your real-time drug levels, which is not completely novel. There are just other apps out there like Shotzi and different things that have done that. But what we do is something that nobody else has done.

SPEAKER_06 23:16

Okay.

SPEAKER_00 23:17

Which is to say we're going to use that information to allow you to set a target level and to calculate the real-time dose required to stay there. Okay. And if you want to go up, you adjust your target level up. If you want to go down, you adjust your target level down. And it really turns GLP1 therapy into a thermostat for your appetite. I want a little more control. You nudge it up. You don't turn it up to 120. You turn it up from 71 to 72, right? That's what you do in your house. If it's like, hey, that was too strong last week. Couldn't eat. Don't bounce off the medicine. Turn it, turn it down a little bit. Okay. And the app that we have gives you the ability to adjust your dosing with an incredible amount of precision, but not just the dose. We can also adjust the frequency. Okay. And this is something I want I want you to really understand. Because with standard weekly dosing, you hit a peak, okay, your maximum drug level after an individual injection at about a day after. Yep. And then you slowly tail off. Okay. How many of us have had this experience where you can't eat on day one? Middle of the week, you feel pretty great.

SPEAKER_06 24:26

Yeah.

SPEAKER_00 24:27

End of the week, you're starving. Yep. Okay. Well, let's think about this. Your peak level reached a level at which you couldn't really eat. Is the answer to go up?

SPEAKER_03 24:39

No. The answer is.

SPEAKER_00 24:40

No, right? Don't increase your peak level because it's already possibly even a little too high. Yeah. You certainly don't want to increase your dose. But what do we do about those last two days where you're starving and you ate back all your losses? Okay. A primary care doctor would say, let's increase your dose. Because what other option do they have? It lasts longer. Exactly. But then you're condemning yourself to side effects, right? What we say is no, keep your peak the same or maybe even drop it a little bit. But let's find the point at which that hunger comes back and let's calculate the dose from there. Let's find that treatment ban. For you, it might be two milligrams every five days that keeps you in that sweet spot. For someone else, it might be six milligrams every seven days. For someone who's very sensitive, they may have a very fine window. Maybe they have to take a dose every three days to stay close enough to that line to have a good effect without their appetite roaring back.

SPEAKER_03 25:36

So for the adjusted dosing, you know, I'm a little bit, I'm not a physician, so I'm a little bit hesitant to suggest people adjust their dose on their own because people do all sorts of things. Yes. Right? So how do you do this safely? Because some people are taking this for diabetes. And they, you know, I don't want to tell them just do whatever you want.

SPEAKER_00 25:54

Like well, and I don't want to either.

unknown 25:56

Okay.

SPEAKER_03 25:56

So the how do they do this safely?

SPEAKER_00 25:58

Yes. So first of all, the app is only under only available under supervision.

SPEAKER_03 26:03

Okay, great.

SPEAKER_00 26:03

Okay. It's not available in the app store. We hope that we can prove to the FDA eventually that it's good enough to do that way. But for now, it's available through our clinic or through about 20 or 30 other clinics who are also utilizing this technology. Okay. The other piece here though, in terms of safety, all right, by definition, if you can get your dose lower and ensure that it's tolerable, it is safer than recklessly increasing and doubling your dose every five weeks, right? Right.

SPEAKER_03 26:33

But I just don't want to like try to medically manage some person with severe diabetes. Yes. You know what I mean?

SPEAKER_00 26:39

Like nor should you. Like this for for now, for sure, this needs to be under medical supervision. And we have a network of clinics now that are using this, and we, you know, use it in our clinic. Right. Okay. That being said, here's the key precision medicine.

SPEAKER_06 26:52

Okay.

SPEAKER_00 26:52

Small, frequent adjustments to stay in a sweet spot. Okay. That can never be clinician dependent. Because what doctor has the ability to manage micro adjustments on a weekly or bi-weekly basis for a thousand patients? Not we have to find a way to empower patients to safely make adjustments under supervision and within boundaries to be able to adjust their own experience. As a very easy example, okay, ibuprofen. Does ibuprofen have risks?

SPEAKER_01 27:27

Yeah.

SPEAKER_00 27:27

Hell yeah, it does. Okay. Cause a lot of problems if overdosed. Okay. So what do we do? There's a safe range, 200 to 800. Okay. There's a safe, you know, interval for you to take it. Okay. Do you call your doctor every time you decide to take 400 milligrams of ibuprofen instead of 200? No, of course not. No. Because you have the safety boundaries, you know what is okay to take, and you can make a rational decision on how much to take because you know how you need to feel.

SPEAKER_02 27:56

Right.

SPEAKER_00 27:56

Okay. With our app, same thing. There's still limits. You don't get to take more than the prescription. You can take less, though. Sure. And you can take it more frequently. Okay. As long as your total amount that you take stays underneath your script. So the way we think about it is the script is a cat, the script is a cap. Anything under that, you should be able to self-adjust because by definition, I'm so sorry. By definition, it's safer to take less medicine than it is to take more.

SPEAKER_03 28:26

Right, of course. All right. Of course.

SPEAKER_00 28:27

So the goal is maximum patient autonomy and maximum safety.

SPEAKER_02 28:33

Okay. Okay.

SPEAKER_00 28:34

But again, it's all under supervision for now.

SPEAKER_02 28:36

Good.

SPEAKER_00 28:37

And you know, we run a concierge clinic where our patients have our cell phone numbers, and if they have a question about their dosing, they just ask us. You know, that's not the case for a lot of telehealth groups. We're we're working towards making this more widely available and having actually having a network of clinicians that are trained in this that can respond to those type of adjustment questions that doesn't put that burden on the primary care physician. So we kind of have a plan to make this scalable. If you're having side effects, if you're not tolerating these medicines, if someone's racing you up a ladder and you're like, I you know, please, doc, please don't increase my dose. I already can't eat. You know, I really hope and pray that this becomes the standard of care because it is so dramatically better. And the only reason people don't do it is because it's hard and it's a lot of math. So somebody had to solve that piece of it. But I think we have. So I think individualized dosing is actually a possibility now.

SPEAKER_03 29:30

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SPEAKER_00 31:18

Fantastic question. And the answer is yes. Okay. So, first of all, once you've reached your weight loss goal and you're trying to maintain whatever that physique is, okay, do you always need the same amount? I know I don't.

SPEAKER_03 31:28

I've been stuck with five because of yeah, well, let's talk about I'll just give my own example.

SPEAKER_00 31:33

I'm on a GLP one about a third of the year. Why? Because when my life is under control and my schedule is good and I'm not traveling a lot and I'm not stressed out, and I have all the structures in place, I don't need a GLP one to maintain my weight. Okay. You layer on the holidays, travel, something stressful happen at work, and you know, I'm out of my normal routine. Appetite becomes a real problem. Okay. Well, I know that about myself. I've inhabited this body for 42 years. I know that I'm gonna gain five pounds over the holidays if I don't do something about it. And so what I do is cycle back on for that period of time and then cycle back off. Well, how much do I take? Well, I titrate up until my hunger is controlled. And on a dose-to-dose basis, I decide based on where I'm at right now, my own life experience right now. Was last week's experience good? Do I want to nudge it up a little bit? Do I want a little more control? Do I want a little less control? Maybe there's a special occasion that I'd actually rather have some room to eat a little more for, right? It just gives you the ability to create your own experience. Okay. Some people may need to be on these medicines every week for the rest of their lives. Right. Some people may just need them occasionally. Okay. Some people need them at a high dose for a long time. Some people need a very small amount occasionally. The whole point is you should be able to choose what works for me at this point in my life. What do I need? And having the option or visibility or ability to make those adjustments is everything. So for you, I would put in your previous doses, the last, you know, five weeks, so I know where your steady state is. I would then, if your goal, if you're my patient, says, well, I want to be on a lower dose and still be able to maintain, we would decrease that max level where you're at right now by 2% each dose until you go, I can't go any lower. My hunger's a little out of control. Then what would we do? Nudge it back up a little bit, and that's your level for now.

SPEAKER_06 33:30

Mm-hmm.

SPEAKER_00 33:30

Until your body adjusts or changes or you age or something changes hormonally, whatever it might be.

SPEAKER_06 33:35

Right.

SPEAKER_00 33:35

But we find that sweet spot. Okay. From there, it's very simple. You take that dose and you go, when does my hunger come back? When does it get out of control? And guess what? That's the day you take your next dose. How much do you take? Well, the app will tell you. It'll tell you exactly how much to take to get back to that same experience that you liked the last time, right? The other beauty with this is let's say you're traveling. Maybe you don't want to take your medicine with you.

SPEAKER_06 34:01

Mm-hmm.

SPEAKER_00 34:01

Okay. What if your scheduled dose lands right in the middle of your trip? Without a tool like this, you'll either take it early, which by definition, you will overdose. Yes. Your level will be too high. Or you'll say, I'll wait till the end and take it when I get back. But which by definition, if you take the same dose too late, your level will be too low.

SPEAKER_02 34:21

Right.

SPEAKER_00 34:22

Okay. Wouldn't it make more sense to take a dose right before you left? That would just keep it. That would get you right back to where you want to be for your trip and then take another dose at the end to get right back where you wanted to be and then maintain that. Well, again, it begs the assessor question how much do you take to do that? Turns out you need some an app to tell you. But once you have that information, it is trivially easy to use these medicines as tools and for you to stay in control.

SPEAKER_03 34:49

Right. I mean, that's that's what's missing from my life. And it's been because I've been locked into insurance. Now I'm not, but like, you know, I'm not gonna not I'm not gonna say no to $25 a month medication.

SPEAKER_00 35:01

You know, I would argue, I'll just throw this out there.

SPEAKER_03 35:04

Yeah.

SPEAKER_00 35:05

If you keep your dose down, okay, because you don't overshoot, you don't race to the top. You keep your dose down and you find a reputable, so important, quality, vetted, third-party tested compounding pharmacy, and you get meds at cost, which are available through my clinic, through some other avenues as well, yeah, you're probably not gonna pay much more than that per month in medication cost. You know, I'm not gonna promise that. You may pay a little bit more, sure, but the cost difference is not as significant as you might think. Okay. Now, for most people, if I said, you know, 50 bucks a month is the difference between you having complete control over your appetite and your GLP1 experience, avoiding side effects, working around travel, being able to manipulate up and down and sideways to add the experience you want, or locked into a drill sergeant that tells you what to eat, when to eat, how to feel, when to take it. There's no contest.

SPEAKER_03 35:57

No, you know, like the freedom is is definitely worth it to be able to like have a little flexibility, live your life, but that's really my goal.

SPEAKER_06 36:05

Yeah.

SPEAKER_03 36:06

To live a life that involves travel and eating and doing the things, but also being able to be healthy.

SPEAKER_00 36:12

That's that's where my passion lies in this stuff is you know, I came from a background which was like amateur bodybuilding, where, you know, ultra restrictive lifestyles where you counted every calorie, you weighed every gram, you avoided social events because the food was going to be there, you didn't go on vacation because the food in Italy is gonna taste too good, and your life becomes so limited. Okay. Well, GLP ones kind of do that too when you take too much. They put you in this little box where I can't eat that. I can't go on a trip and not get sick. You know, I have to take this with me at this particular time in order to have this experience. Okay. I prefer, rather than them being a drill sergeant that tells you what, where, and how and why, it's like it's a companion that helps when you need it as much as you need it. You know, like that example for me, like some of the year, I don't need your help. It's like, thanks, I'm good. And then it's like, wow, I'm so glad I have you in my fridge. And I'm glad I know how much to take to get me through this rough patch and still have the body and health that I want without having to dedicate my entire life to the pursuit of fitness. I mean, that's the other key with this is anyone can have an amazing body if they dedicate every minute of every day to it. Of course. Okay. But that's not much of a life in the end. And so the best way, in my opinion, that these medicines should be used is to freedom. Give you the freedom from being a prisoner of your appetite and also be free from the drill sergeant nature of the medicine, too. There's a middle ground there where you get to have the life that you want, you know?

SPEAKER_03 37:45

That's that's all I that's all we all want is some freedom. So where can people find out about your practice and uh your app and all the things? Yep.

SPEAKER_00 37:52

So the website is voafit.com, vs and victor, o a f I t dot com. Uh, there's an explainer page. It's voafit.com backslash my level. It teaches everything about how why we dose this way, how it works, the pharmacokinetics. There's several videos you can watch and just walk away from that with a good understanding of what we do. On the website as well, uh, there is a white paper that I've written that's actually a description of that initial patient cohort where you can read through our actual patient outcomes and just have a good sense of, you know, who we were, what we were doing, the average dosing, kind of how you know all that data shook out. And then on social media, my handle on almost every platform is at voifitmd. The exception I think is Facebook, where it's E and L S M D. And then uh, you know, you can find us on quite a lot of platforms if you just Google my name. I've done quite a few of these podcasts and things like that. So there's a lot of information out there too. Yeah, awesome. If you want to reach out personally, you can email me at md at voifit.com, or you can contact the clinic administrator's email, which is hello at voifit.com. Thank you so much. You're so welcome. And I just I'll just leave with this. I said it to some degree in the beginning. These medicines are too important to fail. They're too important for 40 to 70 percent of people to quit in the first year, for 40% of people to quit in the first month or two. Okay. You know when most people quit statistically, it's week five.

SPEAKER_03 39:17

Yeah.

SPEAKER_00 39:18

I wonder why. Okay. When you understand the math, it's obvious they overshot, they took too much, they felt terrible. Who would want to live that way? Okay. They should be given the opportunity to stop that climb when they feel good.

SPEAKER_03 39:32

Yeah. Absolutely.

SPEAKER_00 39:33

And if you do that, then you know, the world opens up to you.

SPEAKER_03 39:36

And that's that's the point. We want to just feel our best. So thank you so much. I really, really appreciate it.

SPEAKER_00 39:42

You're so welcome. Thank you.

SPEAKER_03 39:43

Thank you so much to Dr. Ellis for sharing his insight about GLP1 dosing because I really feel like this is an area that is not very well understood and could, you know, really benefit if you can get the perfect dose for you and your goals. And if you want to stay in touch with the GLP1 Hub, and I send out a newsletter every single Tuesday. It's called the Steady State newsletter, and it's about nutrition, diet, uh, all the new things coming out in the GLP1 space. If you want to sign up for that, you can find the link down below in the show notes and get a free meal plan while you're at it. And I'll see you in the next episode.