Beyond Peptides: Building a Lasting Weight Loss Foundation with the Popkin Method

Welcome to The Popkin Method, where we cut through the noise of miracle weight loss solutions and trendy shortcuts dominating social media and advertising today. In this episode, Dr. Matthew C. Popkin takes a deep, clinical dive into GLP-1-based therapies like semaglutide and tirzepatide, some of the most talked-about tools in modern medicine. But here’s the catch: these medications aren’t magic fixes. Instead, Dr. Matthew C. Popkin unpacks the importance of a comprehensive, sequenced approach that prioritizes lifestyle optimization, strategic nutrition, resistance-based training, and targeted supplementation before even considering medication.

We’ll explore why so many struggle to keep weight off after stopping these peptides, why even lean individuals can battle insulin resistance, and how stacking the right peptides with solid foundational habits creates sustainable results. This isn’t about chasing the next health trend, it’s about reclaiming control of your physiology and building a system that actually works for the long-term. Let’s get into it.

Timestamps:

00:00 Success with GLP1 weight loss peptides

03:58 Critiquing wellness influencer marketing

10:22 Navigating modern marketing challenges

11:57 Supervised weight loss and lifestyle changes

14:42 Understanding Skinny Fat and Metabolic Health

19:29 Prioritize fiber and healthy fats

21:46 Spacing Protein Intake

26:23 Maintaining Muscle with Diet and Exercise

28:22 GLP1 therapies and liver health

32:50 Prepping your body for medication

34:20 GLP1 Medication Reset Protocol

37:31 Peptide stacking with physician guidance

40:54 Choosing the right peptides

46:51 Addressing Insulin Resistance Strategies

50:47 Avoiding medication dependency

53:22 Understanding the Popkin Method

55:04 Introduction to the Popkin Method

You can see Dr. Popkin through his online virtual functional medicine program anywhere in the country or the world for that matter.

You can visit Dr. Popkin in his Hollywood Florida office for an in person weight loss experience.

Visit thepopkinmethod.com to send a message to schedule an appointment with Dr. Popkin or email Dr. Popkin at mcpopkinmd@yahoo.com.

Podcast Website - https://thepopkinmethod.com/

Matthew C. Popkin, M.D. - https://thepopkinmethod.com/about

Podcast Partner - TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Transcript

SPEAKER_00 0:12

Welcome to the Popkin Method. Today's episode is one that cuts straight through the noise. Because right now, everywhere you look, social media advertisements, even casual conversations, there's a new miracle solution being promoted. A peptide, a cleanse, a shortcut that promises to override years of physiology with a single intervention. But the question we should be asking is this are these tools actually fixing the problem, or are they just masking a system that was never built correctly to begin with? In this episode, we're going to take a deeper, more clinical look at one of the most talked-about categories in modern medicine, GLP1-based therapies like semaglutide and trisepatide, and how they fit into a much broader, more comprehensive strategy. Because in the Bopkin method, the medication is never the foundation. It's layered on top of lifestyle optimization, strategic nutrition, resistance-based training, and targeted supplementation. We'll also explore the role of peptide stacking, insulin resistance, even in lean individuals, and why so many people struggle to sustain results after coming off of these medications. Most importantly, this conversation is about reclaiming control of your physiology, not chasing the next trend, but building a system that actually works. Let's get into it.

SPEAKER_01 1:27

Thank you, Jamie. Hello, everyone, and welcome back to the Popkin Method. If you've been following this podcast series from the beginning, thank you very much. We've passed the midway point of this series, and I think it's the perfect time to give an update on the current GLP1 weight loss peptide landscape. I had done a previous podcast episode, I believe it was episode two back on July 12th of 2025. So it's been about 10 months and a lot has changed. So I want to give everyone the update. At its core, the Popkin method is a structured phased system. And when it comes to the GLP1 peptides, the same rules apply. It begins with the foundation, lifestyle modification, diet, exercise, along with basic and targeted supplementation. And if you truly clean up these four pillars, you can often make meaningful improvements in your weight loss and wellness goals. Then, when clinically appropriate, we can consider the next layer, such as peptide therapy with the GLP1 medications, peptide stacking strategies that support the GLP1 peptides. Others include mitochondrial support strategies like NED plus, which we discussed at length on a previous podcast episode, hormone modulation, and in selective cases, a bioedental hormone replacement, followed by more advanced biologic therapies if needed, like stem cell exosome, and secretome-based regenerative strategies. But the order matters, Jamie, as we talk about all the time, the sequence is what protects the patient from chasing shortcuts. And it's also what makes the results more sustainable. So today I want to show you what this looks like in the real world as it pertains to the GLP1 weight loss peptides and the obstacles that patients are having with them in really in reaching their weight loss goals. And the good news is this in most cases, there is a clear, structured, highly actionable path to improving physiology that contributes to the success of these weight loss peptides. And that path maps beautifully into the Popkin method. So in today's episode, we're going to break down and discuss the concepts necessary for your GLP1 weight loss peptide success. So let's get into it.

SPEAKER_00 3:31

I love it. There's a right way and a not so right way to do this to get the best results. So I'm excited for this conversation today. Okay, Dr. Popkin, everywhere we look, social media, ads, influencers, there's this numerical peptide cleanse supplement, something that is promised to be, like we said in the past, like that magic bullet that's really just going to transform your life inside and out. Um, what is actually going on?

SPEAKER_01 3:58

Well, Jamie, what we're seeing here is a very sophisticated form of marketing built around a very human instinct. We all want a quick fix. We want something simple that creates a dramatic result. But here's the truth. And we've been talking about this from the beginning. The human body, when functioning properly, is already the most powerful health optimization system we have. What disrupts the system is not a lack of supplements or peptides or other treatments, it's poor nutrition patterns, it's sedentary lifestyle, chronic stress, poor sleep, environmental inputs, and yes, to some degree, a genetic predisposition. And then we layer on top of this the idea that we can supplement or peptide stack our way out of it. And the other issue, and this is really important, is who is actually delivering this message, right? I mean, there are many Instagram, Facebook, and TikTok influencers out there that are promoting peptides and they have no formal medical training, zero credibility, zero coordination of care with your existing medical conditions, no responsibility for outcomes, no longitudinal follow-up, and they're often financially incentivized. And yet, despite this, Jamie, so many people are just buying into the hype. And the common phrase, you know, click on the link below for my discount code, meaning click my link below so I can get comped on your purchase. You know, it's so prevalent in today's social media, and people are buying it, you know, because this person looks a certain way. Most people want to emulate that and they get influenced to purchase something that likely won't have any meaningful, lasting change for the good of your health. So the guidance becomes disconnected from actual patient care. And the reality is this if you allow the body to function the way it was designed through proper nutrition, metabolic spacing, and recovery, it'll outperform almost anything being sold online. So strategic fasting is a perfect example, Jamie. It allows insulin levels to normalize, it activates cellular repair pathways called autophagy. Uh, it restores metabolic flexibility and it costs you nothing. You can do it today. And all of a sudden, the body is now able to do what it was built to do. And that's not a hack, that's physiology.

SPEAKER_00 6:10

All right. So walk us through the different peptide pathways involved in weight loss. You know, there's a lot of different ways to get there, but let's focus on the peptide part.

SPEAKER_01 6:20

Yeah, so there's been significant progress in this space, and I don't want to geek out too much on this or go too uh into the weeds on the uh the biochemistry here, but most people are familiar with the medications like the GLP1 receptor agonist, semaglutide, and the GLP1 GIP receptor agonist terzipatide. And now the newest addition, which is the GLP1 GIP glucagon triple receptor agonist, the retotrutide, that recently cleared phase three trials, and it's all a rage as people typically want the newest shinies toy that's out there. Recently, however, believe it or not, a new five-receptor drug has been hypothesized and at the biggest diabetes conference of the year, which is the ADA 2026, the American Diabetes Association 2026 conference. And this new drug concept will hit five receptors, including receptor four, which is amylin, and receptor five, which is calcitonin. And the drug companies are scrambling to create this drug at some point in the future. And this new medication will likely be the strongest pharmaceutical drug ever tested in humans for weight loss. I mean, can you imagine that? We have five receptor agonists that are trying to control something that really can be fixed with lifestyle, diet, exercise, and uh some basic supplementation, really cleaning up your lifestyle. But here we are creating drugs that that affect so many of these pathways. So, broadly speaking, let me describe the different pathways and what they're responsible for doing, right? So the GLP1 pathway that enhances satiety or feeling of being full, and it slows gastric emptying, and it's really the appetite killer, and that's the semaglutide. And then there's the GIP pathway. When you add that to the GLP1 pathway, the GIP pathway plays a role in insulin signaling and metabolic efficiency, and this is the fat killer. So that two receptor agonists, that's your trzepatide. And then you add in the glucagon pathway, which can increase energy expenditure and fat utilization. You can consider this the gas pedal for weight loss. So all three of those, that's the retotruptide. Then you add in receptor four, which is the amylene pathway, which slows the stomach even further, it kills cravings, and it keeps you full for hours. And then the fifth receptor pathway is the calcitonin pathway, which suppresses appetite from a completely different pathway from the other ones. So you can see here, these are very powerful biochemical pathways that we are monkeying around with. And they're it's quite effective, but again, none of these things are going to be as effective if you don't correct the uh the underlying problems. And in a lot of cases, if you correct the underlying problems, you don't even need these medications. So, this ongoing research into these multi-agonist therapies targeting multiple pathways simultaneously, which may further enhance metabolic outcomes, is being aggressively pursued by the major drug companies. So these drugs are coming, and this is a billion with a B billion dollar industry. The first to market stands to make even more profits compared to the current billion-dollar products we're using today. So the key takeaway is this, though, Jamie, and it's always the same message. These medications don't override your physiology, they modulate existing pathways. And without the right environment, even the most advanced therapies will underperform. So the Popkin method creates the proper environment to allow the body to perform as it was intended. And if more aggressive therapies are needed, then the Popkin method allows these modalities to obtain their highest benefit.

SPEAKER_00 9:56

Absolutely. And then we're not overdoing it one way or the other. And again, I think longevity is something that you're always preaching and a huge proponent of, and taking care of what we need to take care of relative to the physiology first, and then putting the band-aid on whatever sort of wound uh is left is a much better way than perhaps over-medicating something that we don't need to and masking that problem. Is that right?

SPEAKER_01 10:22

Yeah, we we jump on the marketing and so much so that you know you see the commercials on TV, people, you know, they they get their information that way. But, you know, like I said before, people will take information from Facebook, LinkedIn, and Twitter, Instagram, and they'll listen to people who have absolutely no authority and they'll just click and buy because they see, you know, someone pretty or they see something that they want to emulate. And this is the landscape today, and it's it's sad. So we're trying to cut through all that and give people the information that they need. And for the most part, if you clean up the you know, your lifestyle diet, do some exercise, take some basic supplements, you can correct most of what's causing your weight gain and you don't necessarily need these peptides, but some people need them, and of course, you know, we we're happy to use them in selective cases.

SPEAKER_00 11:11

And what I think also is really interesting, I'm always served to ad with Serena Williams promoting the GLP one. I can't remember exactly what it is. It's purple, but you know, I think people don't consider that if a professional athlete or someone who is in excellent shape, right? Maybe a professional dancer, doesn't matter, um, is using these things, they're probably already monitored by medical professionals like yourself, that has them doing all of the right things. So it is probably administered in the right way. And I think a lot of people don't realize that. They're like, oh, well, if she's doing it, then I'll do it. But again, we're skipping that foundational step, right? Which is probably already set, especially with the people who are, like I said, professional athletes.

SPEAKER_01 11:57

That's a great point. You would think that that professional athletes and actors and actresses and people that are in the entertainment business, you see this all the time, this massive weight loss that occurs in these patients. And yeah, you would hope that it's being done in a supervised fashion and a safe fashion. And the idea is that you treat, and while you're treating with these peptides, you're correcting the problems that led you to this in the first place, so that when you eventually stop taking them, that problem doesn't come back, right? We don't want to regain the medication and we uh the weight, and we don't want you on the medication for the rest of your life. The drug companies do, but you know, ideally, if you can correct the things that we talked about, lifestyle, diet, and exercise, you can really fix most of your weight loss concerns. And again, there are some people that need it because of genetics. And we're gonna talk about this, you know, coming up here in the podcast. You know, you can be thin and and and appear healthy, but still be insulin resistant.

SPEAKER_00 12:57

All right. Well, that leads perfectly into my next question. We don't think that perhaps people that are thinner would have an insulin resistance problem. Is that is that true? Is is insulin resistance only a problem for overweight people? How does how do we rectify that?

SPEAKER_01 13:13

Yeah, I mean, not at all. And this is one of the most dangerous misconceptions. You know, thin people are often insulin resistant due to their habits and lifestyle. And a significant portion of adults, even those that appear lean, they show evidence of insulin resistance. And in fact, a 2021 analysis of national health data found that 40% of US adults aged 18 to 44 are already insulin resistant. And not all those people are overweight, not even close. And there's actually a term from what I'm for what I'm describing, and it's called skinny fat, which is someone who looks lean on the outside, but has very little muscle and has fat around their midsection, and in particular, enough fat around their organs on the inside to drive insulin resistance. And this phenotype, referred to as skinny fat, can be characterized by anyone with low muscle mass, high visceral fat, which you can see around the central adiosity, as well as on DEXA scan and CT scan, you'll see fat on the inside around the organs. And that's very dangerous fat. And they may even appear have normal weight on the scale. And metabolically, though, they may resemble someone with obesity, even though they're not overweight. And here's why muscle is the primary site of glucose disposal. So if muscle mass is low for whatever reason, you're under-eating, you're not getting enough protein, you're not exercising. So if your muscle mass is low, glucose handling becomes inefficient. We've talked about this on previous podcasts. Insulin levels rise, and insulin is an anabolic hormone that stores calories as fat, and fat storage increases, especially viscerally around the internal organs. We're going to talk more about this as the podcast goes on. And these are key signs of being skinny fat, right? Energy crashes after meals, central fat accumulation, sugar cravings, and fatigue. Again, these are things that most people experience. But understand that the scale does not reflect your metabolic health. Body composition does. So remember that a key component of the Popkin method is to gain and maintain as much muscle as possible because muscle is your most potent, powerful glucose management system in the human body. And the more muscle you have, the better your body can absorb glucose from the bloodstream and actually use it as a fuel source rather than storing it. So someone with very little muscle has much smaller glucose disposal capabilities. So even when eating normally, their body struggles to maintain blood sugar, eventually causing a pro-inflammatory involvement. We talked about this in other podcasts, as well as glucose fluctuations and insulin resistance, even though they're thin. So we discussed this at length as we talked about. And this can lead to fatty liver disease, which creates a vicious loop, keeping you unhealthy and stalling your weight loss. So if you're not overweight, but you're sedentary, you have low muscle mass, especially if you carry fat around your midsection, you should really see your physician and get some labs tested, in particular, fasting insulin level, some inflammatory biomarkers, cholesterol, and other measures of diabetes and take a look at and see if you're if you're truly healthy on the inside. And remember, scale is not telling you the full story of what's happening on the inside of your body. So, you know, get yourself checked out, get some biomarkers tested, and look deeper than just other people that are on Instagram touting these miracle injections.

SPEAKER_00 16:37

Wow, such great points. And yes, we give way too much power and importance to the number on the scale, especially I think when you're trying to lose weight, right? Muscle weighs so much more than fat. And I feel like usually if you start working out a lot, you usually see perhaps maybe even a weight increase before a weight drop because you're building that muscle faster and the muscles weigh more than the fatty. You're kind of doing both at the same time. Is that right?

SPEAKER_01 17:02

Absolutely. That's a great point. Your your scale weight, I always tell people, you know, it it's not as important as you know, as your body composition. And exactly, you'll people start exercising, they'll eat better, their weight will drop because they'll get rid of some excess fluid or they'll get rid of some fat. And then their weight loss will stall. But really, it's just the scale weight that's stalling. Their body, they're still losing fat, they're gaining muscle, and their body is reproportioning. And they'll tell me they're concerned, I'm not losing weight, but my clothes are fitting better and I look better, right? So you can see how the mentality of people is so geared around a number. And if your scale weight is is not moving as fast as you want it to, even though your body composition is getting better, your clothes are fitting better, people are still upset because they're focusing on the wrong thing. And they're focusing on the wrong thing, unfortunately, because of what we're hearing and seeing on social media. Everyone wants that weight loss, they want to see you know, pounds come off, and no one's giving them the proper information. So, again, just like you said, muscle weighs more than fat. So don't just look at the scale weight, look at your body composition.

SPEAKER_00 18:09

Yeah, and I'll never forget when I was getting ready to compete in Miss Georgia and was working with a personal trainer. The first time I met with him, he was like, You're skinny fat. Because I wasn't doing a lot of weight training in the past, but uh not obviously in the clinical way that you were explaining, but uh yes, dude do have a little PTSD with that. All right. So speaking of when you lose weight, and perhaps if you like stop eating so much, which is what happens when we're on a GLP1 medication, uh, we can be losing muscle instead of fat, right? So if someone is on a GLP1 medication, how should their diet be structured?

SPEAKER_01 18:53

Yeah, that's that's a good question, Jamie. You want your nutrition to work with the medication, not against it. And this is a really important point here, regardless of whether you're taking the GLP1 peptides or not, your meals should have these three components. Number one, you should prioritize protein. You're supposed to get about a gram of protein per pound of ideal body weight. So, regardless of what your weight is, if you're 200 pounds but your ideal body weight is 150, then you want to try to get about 150 grams of protein spaced throughout the day during your eating windows, because most people I have doing some form of intermittent fasting. Second thing is you want to emphasize fiber with veggie carbs or vegetables, and you want to limit the starchy carbs, so the bread, rice, potato, pasta, cereals, and sweets that are pervasive in our diets. And then you want to prioritize healthy fats, so things like extra virgin olive oil and avocados. So a strong example of a very metabolically aligned breakfast would be eggs, avocado, and a protein source like turkey bacon or sausage. And what this does is this creates a high protein, healthy fat, minimal glycemic load diet that basically, or meal that keeps your insulin levels low and works with the medication instead of against it. And even if you're not on the GLP1 medications, again, the concept is we're keeping insulin low and therefore we're burning fat. So compare that to a breakfast that is oatmeal, granola, toast, and fruit juice, things that people think are healthy and they're horrible because what they do is they spike glucose and insulin early in the day and they set you up for insulin resistance. And then they also set you up for that crash you get midday, which makes you now reach for snacks, and you tend to crave sugary carbohydrate snacks, which worsens the problem. And again, your core framework should include whether you're on the GLP one medications or not, they should include prioritizing protein, emphasizing fiber from vegetables, because that fiber will help to keep the glucose spike down as well, and include healthy fats like olive oil and avocado, and minimize the refined starchy carbohydrates that I mentioned: bread, rice, potato, pasta, and cereals, especially the boxed cereals and sweets. So practically most patients underestimate their protein goals by far. And your goal, again, should be one gram of protein per pound of ideal body weight. And Jamie, most people have no idea how much protein is in certain foods. So I'm gonna give a cheat sheet for everybody. And I usually put my patients on the spot and ask them, you know, how many grams do you think are in, you know, an egg or or an eight-ounce steak or whatever. They have no clue. Uh that's why I tell people to get a macro counter, it'll do the work for you. But a quick little cheat sheet here is the following foods have about 30 grams of protein. And 30 grams is about right for a meal load, right? You don't want to, you know, have too many grams of protein. You want your body to be able to absorb them and use them throughout the day. So you want to have these in smaller meals. You don't want to take 150 grams of protein in one meal, which probably would pretty much be impossible, but you want to space. It out so 30 grams of protein are in things like four ounces of chicken, a round beef that has about 30 grams of protein, five eggs, ten shrimp, a cup of cottage cheese, a cup and a half of Greek yogurt, two cups of beans or legumes. So that'll give you an idea of what 30 grams of protein looks like. And remember, I keep saying it, you want one gram of protein per pound of ideal body weight. And you want to space that out through your eating window. We'll talk more about the fasting windows later on the podcast.

SPEAKER_00 22:28

Excellent. All right. What are some common reasons that a GLP1, the results can plateau or slow down?

SPEAKER_01 22:37

Well, I mean, Jamie, this is something I deal with on a daily basis. And it's usually from patients who come to me from other peptide programs and other physicians. And believe it or not, it's rarely the medication, it's the system around it. I can tell you how many patients come in and they say, I don't think the medication's working anymore. I don't know if I'm getting, you know, good medication. I don't know, I'm not on the right dose. I need to be on a higher dose. And they all have the same panic because they're not getting the weight loss that they're looking for. They initially did, and then it stops. So some key issues and optimizations that I recommend are the following. First, I talk about is timing and metabolic spacing. What this means is, you know, I don't I want people to avoid constant grade uh grazing, and I want them to utilize strategic fasting windows to improve the insulin dynamics. So we talked about this in previous podcasts. Typically, I want everyone to fast, all my patients, I want them to fast for about 12 hours in the day. Most people do this anyway. If you have dinner at six to eight o'clock at night, and assuming you don't snack at night and you sleep seven or eight hours, by the time you get up and you have something to eat, you're pretty much at that 12-hour window anyway. So you should do that 12-hour fast about four or five days out of the week. And then for the other two or three days, try to do a 16 or an 18-hour fast. So you're really fasting for a good portion of the day. And what this does is it keeps the insulin level low, it normalizes your insulin resistance. And the important point here is that you still need to hit your calorie and your protein goals during your feeding window. So if you're on a 12-hour fast, you've got to get those calories in in those 12 hours. Similarly, if you're on a 16-hour fast, you've got to get those calories in in the eight-hour feeding window. If you're in an 18-hour fast, you have to get them in in the six-hour window. So I don't want you fasting for the sake of limiting your calories. I want you creating a minimal calorie deficit. You know, I still want you having in the 1800, 2,000 calories. You still need to get those calories. And more importantly, you need to get your protein goals because if you don't, then your muscle is going to suffer. We we do not want that. The next is hydration. You would be really surprised, Jamie, if you hydrate 30 minutes to 60 minutes before your GLP1 injection, your body will absorb the medication about 40% better when you're hydrated. And most people tend to inject when they're dehydrated first thing in the morning. They get up, they take their shot, and then they wonder why the results slow down. So I tell my patients, with your next shot, drink some water with electrolytes about 30 to 60 minutes prior to injecting and watch your appetite control improve within 24 hours. You're getting significantly more medication in your system by being hydrated. And then I look at the actual injection practices, and you would be surprised at how many people do not know how to inject properly. Most importantly, the biggest mistake I see is people don't rotate the sites. They keep putting the injection in the same spot and the same, they just don't grab if they're right-handed, they'll grab some fat with their left hand, and typically it's right around the belly button region, and they'll just start to they'll inject roughly in the same site. And that's a bad thing because injecting in the same site causes scarring, which decreases the absorption of the drug. So I tell my patients, make sure you're rotating the sites at least two inches apart. And the easiest way to do it is what is one injection do on the right side, and then the next one you do on the left side. And if you go back and forth moving the injection sites in different areas, you will avoid that problem. You know, if you're gonna take the drug, you want it to be absorbed. So hydrate and rotate your sites. And then one of the biggest factors, and it's a common theme in the podcast, we do all the time, is protein and calorie consumption. So this is crucial for muscle preservation and metabolic rate as under eating puts the body in starvation mode, which sabotages your weight loss. And the goal is to achieve a moderate caloric deficit with appropriate protein intake. Most people they think, oh, but they go on the medication and they think not eating is good. And that's not what we're trying to achieve here. We're trying to put you on a dose of medication that will quiet that that food chatter and that food noise so that you don't feel hungry all the time and you don't graze and snack and overeat. But we want you eating and right, we want you in a mild caloric deficit, but we want you hitting your protein goals as well. And the next thing, and this is absolutely not negotiable, is resistance exercise training, right? If you want to preserve lean muscle mass and not be skinny fat, you've got to load the muscles during exercise to achieve muscle growth and maintenance. And most importantly, remember that these GLP1 medications they work best in a metabolically prepared system, not in isolation. You can't give the medication and throw caution to the wind and think that it's gonna do all the work. It's not. The foundation is key, including lifestyle modification, diet, exercise, and some basic supportive supplements. It's the same story, Jamie. You've got to have a good foundation for any type of treatment to work, whether it's the peptides, supplements, stem cells, exosomes, prescription medications, whatever it is, you've got to have the basics in place.

SPEAKER_00 27:52

I love those tips and pointers. I think if someone's listening, those are things that you can implement immediately. I'm not on a GLP one, but I was even thinking, gosh, if I was, this is this is such great info to have. So I hope everyone was taking notes there. That was super informative. We talked a lot in a previous episode about fatty liver and how prevalent that is without you even knowing. Um, but if someone does, can the GLP1 medications help with fatty liver?

SPEAKER_01 28:22

Yeah, absolutely. And there's growing evidence that the GLP1 based therapies can significantly improve non-alcoholic fatty liver disease. And you and I devoted an entire podcast episode to fatty liver and its role in stalling weight loss. And clinical studies have shown that the GLP1 peptides promote meaningful reductions in liver fat, which is very, very important, improvements in metabolic markers, and in some cases, resolution of steatosis or fat in the liver. And these effects are likely driven by weight reduction, improved insulin sensitivity, and reduced inflammation. And if you remember from the podcast episode about fatty liver, it's insulin resistance and insulin sensitivity and inflammation that cause fatty liver in the first place. And here's some really important published data from trials, okay, that show that semaglutide has about a 50% liver fat reduction, which is fantastic. Terzipatide has about a 55% liver fat reduction, again, depending on the dose. But the new retrutide, the triple agonist studies show an 80 to 86% liver fat reduction, which is quite significant. And you might not think that going from 55 to 80 to 86% is significant, but that's a that's about a 50% uh improvement over semaglutide and terzipatide. And more importantly, in these recent trials, 89 to 92% of the patients achieved what we call liver fat normalization, meaning their liver fat dropped below about 5%, which is considered in the healthy range. You're supposed to have some fat in the liver, 5% or less. Put another way, nine out of 10 patients went on to have healthy livers, not just improved, but completely normal. So this is fantastic. Yeah, it's it's it's huge. So these medications do have their place. And to put this into perspective, in separate studies, those results really compare favorably to bariatric surgery. That was the only way we were seeing numbers like this is to do bariatric surgery on people, to do you know, gastric bypass and gastric sleeve procedures. And this is quite significant. And in the proper treatment setting, in the proper patient selection, it's often quite necessary. And if you can use this medication to help get rid of fatty liver and help, again, get the body to function normally, then this is a really, really important tool. But again, remember medication and the peptides, they're the accelerator, they're not the foundation. You've got to support the medication with meaningful changes in your lifestyle, diet, and exercise program. Goes back to the same concepts.

SPEAKER_00 30:57

I'd be curious to know the percentage, perhaps if there is a decrease in gastric bypass surgeries or bariatric surgeries since these GLP1s were introduced.

SPEAKER_01 31:08

Yeah, this is why we're getting a lot of pushback from the FDA on the medications that are being used in compounding pharmacies, right? Because we're taking away from the pharmaceutical companies and branded medications, and you're going to smaller compounding pharmacies. And what that's doing is it's disrupting uh the flow of funds, so to speak, to the large pharmaceutical companies. And at the same time, it's disrupting the whole industrial complex, right? Because if people are losing weight with the GLP1 medications, they're likely not doing as much bariatric surgery. And again, the hospitals don't like that. So, yeah, this is the environment that we're in. And I'm not saying that that the gastric bypass and the gastric sleeve and all the different surgeries are not necessary. I think all of this has to be looked at individually, right? I would never tell someone to do bariatric surgery unless they've failed every possible, including the GLP ones. And initially, it was contra-indicated to put patients that have had the gastric bypass on the GLP one. And now we're doing this routinely. And again, it's understanding how these medications work, what they do, how they affect your physiology. And in the right hands, yes, you can safely do it. In the wrong hands, being guided by Instagram influencers and people who have really no reason to be doing this or no authority to be doing this. In the wrong hands, it's not healthy. In the right hands, it can be really helpful.

SPEAKER_00 32:38

Well, like you said, you've dealt with a lot of patients that have said, you know, it's not working for me anymore, or my results are stuck. Is that a situation where patients should then increase their dose?

SPEAKER_01 32:49

This is another, again, this is this is the mindset, right? If uh if two and a half milligrams is good, five must be better. And then if five is good and a half must be better. Um, and this is a major mistake and it's a major misconception because these higher doses can lead to under eating, muscle loss, metabolic slowdown. And the real trick here is to have the basics in place before you even start the medication, which means you need to have lifestyle modification to make sure you're getting proper sleep, managing stress properly to make sure you're prioritizing protein, fiber, and healthy fats. You want to make sure you're doing proper resistance exercise training to gain and maintain muscle mass. And then make sure you're taking the core five supplements to help these medications work better and help your body work better, and to create that proper environment in your body to help with sustained weight loss, whether you're on the GLP ones or not. So, again, those core five, we talk about omega-3 fish oils to decrease whole body inflammation, pre-probiotics to help improve your gut function, creatine to help with lean muscle mass and decrease brain fog, and D3K2 and magnesium, which helps in over 300 different enzymatic processes in the body. Once you've got all of that squared away, then will the GLP1 medications have that proper environment to work, and it'll help keep your dosage at the lowest effective dose. So before adjusting, fix your nutrition, optimize your training, ensure you're getting good sleep and recovery, and implement some core supplementation. And if you've done all of that and you're currently on a GLP1 medication at a fairly high dose, which is what I see a lot when patients come to me from other from other programs, and your weight loss is not respond, then you need a receptor reset. And it's necessary because of medication desensitization. And here's the medication reset protocol that I use. I'll taper your dose down over two to four weeks, depending on what your dose is at. And then I keep you off of the medication for three to four weeks. We start at the starter dose. Initially, when I tell that to patients, they freak out. They're like, You're stopping my medication. I'm gonna gain all the weight back. And that that doesn't typically happen because what's happening is we're working on the basics, right? And this works because the GLP1 receptors desensitize with prolonged exposure to high doses. So if they did increase their medication, it's not gonna work. They're just wasting medication and they're wasting money. These peptides are not cheap. And the other key is what you're doing during that time off. Again, it includes fasting to reduce inflammation, low carbohydrate consumption to improve insulin signaling, and resistance training to appreciate muscle mass. So these patients aren't going to gain weight during that time that they're off. They should maintain their weight and in some cases maybe go up a little bit or go down a little bit, depending on how bad their habits were while they were on the medication. And then when you restart back at the starter dose, it feels like week one when they first started, right? Appetite regulation is renewed and weight loss resumes, and everybody's happy. And they're doing it on a lower diet with better baseline functioning in their lifestyle, their diet, and their exercise. So this is the way to handle that, not increase, not reflexively increase the dose, but to to be thoughtful about the dose that you're using. And the lower dose becomes more effective than the higher dose when you clean up the environment and allow the receptors to upregulate and let your body do what it's supposed to do.

SPEAKER_00 36:15

Yeah, it's interesting that the body builds up its own resistance to it, similar to like drinking alcohol or pain pills, or really anything, right? So you will hit a peak at some point. Um, so I love that you're restarting it from from the beginning. All right. Again, we love talking about these peptides now. What other peptides, if any, can and should be used alongside the genes?

SPEAKER_01 36:42

So now we're talking about peptides. Amazed to hear the people that are on social media that think they know what they're doing with peptide stacking. And peptide stacking, they think, is just add as many peptides as you can that you can afford, and they should all work together. And ideally, in an ideal world, that would be the case, but it's not. So many of these peptides have different, they function in different environments. Some need to be fasting, some need to be in the morning, some need to be at night. You need to cycle these peptides, and just blindly going on several different peptides wastes time and money and energy and really frustrates people. And now you got people injecting two or three times a day, multiple times, similar sites developing all different types of problems. So, really, if you're gonna do peptide stacking, do it with someone who knows what they're talking about. Uh, don't just follow the Instagram influencer who's injecting three peptides a day and they're you know showing you how great their their their life is now. So, what we do here is now we're talking about optimization, which requires advanced supervision, typically by a physician. And one class of peptides that I like to stack with the GLP1 peptide to improve the outcomes are the growth hormone secretagogs, including tesamorin, CJC1295, epimorin, and syrmorlin. And when I say growth hormone secretagogs, what this means is these peptides allow your body to produce more growth hormones. So we're not injecting you with growth hormone, you're we're injecting you with growth hormone secretagogs, things that make your body produce more of its own growth hormone. So these peptides they support body composition, recovery, sleep, mass preservation. Just Google, you know, benefits of growth hormone and you know, you'll say, Where have you been all my life, right? But in particular, the FDA-approved peptide tesamorin is a growth hormone-releasing peptide that specifically targets that fit fat that I was talking about before. And technically it's called a peptide. And tesamorin stimulates your pituitary gland to produce more of your body's own natural growth hormone, and therefore it helps with sleep and recovery, lean muscle mass, other favorable effects. However, it was originally developed for a medical condition known as lipodystrophy, which is a condition where visceral fat accumulates dangerously around the organs. And again, this is not in obese individuals. This can be in any individual, and it's that visceral fat that is a problem. So this visceral fat isn't just a cosmetic thing. And you need to understand this important fact it's the most metabolically dangerous fat in your body by far because it drives inflammation, it drives insulin resistance, and it increases your risk of mortality, whether you're thin or overweight. So tes moralin is definitely part of my targeted peptide step for a reason because it targets fat that matters most to your health and survival. Now, when I say mortality, I'm talking about death. People that have high visceral fat have a higher risk of heart attacks and strokes and death. So, yes, this is dangerous fat. It's not, you know, this isn't fat that we're looking at and we're trying to be vain and get rid of. This is for your health and your survival. And thankfully, testamorlin also increases muscle density and improves body composition, which is critical in any weight loss and health journey. So it's good, it helps it get rid of visceral fat, increases muscle, does all the things that we want to do. So, what are the drawbacks to test morlin? Well, it's more expensive, and some patients experience side effects at a higher rate than they would with the other growth hormone secretagogs that I mentioned: sermorlin, epomorin, CJC1295. So patient selection is correct. And in the right setting, it's not just cosmetic, it is potentially life-saving, as we talked about. Visceral fat is very dangerous. So then there's the CJC1295 and ipomorlin, which is the more balanced, cost efficient. And this com this combination will stimulate your body's own natural growth hormone production in a pulsatile fashion, which means it works with your biology. That's how our body makes growth hormone in a pulsatile fashion. We take it at night in a fasted state. Your body gets that pulsatile growth hormone night when your body naturally does that anyway. And it benefits a broader category of effects like better sleep, improved recovery, fat mobilization, and muscle preservation. So you're probably asking, who decides, you know, how do I decide who gets what peptide, right? Well, if your budget is not a concern and visceral fat is a priority, then tesomorlin is my choice. If you want more all-around growth hormone, secrete effects that that does everything and is cost-effective but still powerful, then CJC1295 and ipomoralin is the right peptide for you. And this again should be chosen by your physician, knowing your medical history, knowing the other comorbid conditions you have, and putting together a program that fits you, not selling a peptide someone's gonna make some money off of it on Instagram, right? This is this is high-level stuff here, and it should be handled by people who do this on a daily basis. And the slides that I stack with the GLP ones, AOD 9604 is one of them. In my opinion, I think every single GLP1 patient really would benefit from AOD 9604. And what AOD 9604 is a fragment of human growth hormone, but not the part that affects blood sugar and not the part that causes many of the side effects that people tend to get. So it's specifically the fragment that mobilizes body fat and makes it more available for you to consume. It doesn't actually burn the fat, but it's just easier to access so that the body can consume it. And the GLP1 will suppress appetite and create the caloric deficit. AOD 9604 makes sure calorie deficit is pulling from fat, not muscle. So it's selectively choosing fat to burn and not your muscle. And during fasting, low-carb eating, or any sort of calorie deficit, AOD keeps the energy pulling from the right fuel source from your fat, not your muscle. And this is especially powerful for patients with insistence, which makes fat loss incredibly difficult. So essentially AOD helps the body burn fat and not muscle during that caloric deficit, and that's necessary for weight loss. So it's a really good adjunct to the GLPs. And another one that I like to use, MOTS C, everyone talks about this as exercise in a bottle. I'll get to that in a minute. And what MOTS C is, is it's a mitochondrial peptide that can influence metabolic signaling, energy production. Um, and as we discussed, mitochondria are the powerhouse of the cell, right? It's where energy is made. So when you're not making enough energy due to mitochondrial dysfunction, your cells get sick, you feel fatigue, brain fog, slow metabolism, poor recovery, weight gain, aging skin, decreased exercise tolerance. So what MOTS C does is it I won't get too much in the weeds here and geek out, but MOTS C activates something called AMPK, which is your body's metabolic master switch, so to say, so to speak, which tells your cells to produce more mitochondria and to burn more fat, essentially giving yourself. Signal that it gets from intense exercise, which is the reason why they call it exercise in a bottle. And Jamie, you can probably guess I don't like this term for obvious reasons because it implies that you don't have to exercise, which obviously, you know, people do. So I tend to correct people, it's not X in a bottle, it mimics biochemically what happens when your body exercises, but you still need to do the exercise. There is, as of yet, no such thing as exercise in a bottle. So with the GLP1 meds, MOTC becomes an incredibly powerful metabolic accelerator that you can add to your regimen to improve your results. But again, and here's the key uh surprise, surprise, right? These are adjuncts, they're not replacements. They amplify a system that's already in place that just needs some assistance to function better. You've got to have the basics in place. These peptides will not do the work on their own. You got to put the work in too.

SPEAKER_00 44:52

Yes, we cannot put a band-aid on a bullet hole. We need to do the surgery first. Then we can put the band aid. The band-aid is key to healing, it even helps. You not get infections. But we gotta kind of close the hole first. We gotta close the gap first. All right. So let's say I achieve my goal weight on a GLP one, or I don't, and like we mentioned earlier, it stalls. What happens after I stop taking the GLP1 for one reason or another?

SPEAKER_01 45:22

Well, here's the big problem. Weight gain is common if nothing else changes, Jamie, right? Everyone loses GLP1s because they work, but study thirds of people will regain most of the weight within a single year of stopping the medication. Wow. That is not a good number. And here's why it happens the medication it suppresses your appetite, it improves insulin signaling while you're on it, but it doesn't change your body's weight set point. Your body is gonna want to go to where it was prior to starting the GLP peptide unless you make significant changes. And the moment you stop, your body fights to get back to where it was used to being. And the solution isn't staying on high doses of this of this pet forever, it's using the medication treatment window to actually fix what's broken, right? So here's my prevention strategy. And it's going to be the same strategy that I use throughout the entire popkin method. Step one is build some metabolic flexibility through fasting, training your body on how to burn fat as fuel, not just on suppressed appetite. Because typically, when you go on a suppressed appetite, you burn muscle and then you lose metabolic flexibility and you gain weight. So we want to train your body to properly burn fat as fuel when you are in this in this fast state. Step two, preserve muscle with protein and resistance training. Muscle is your metabolic engine, it's your glucose reservoir. If you lose it, you're setting yourself up for weight regain. So gain and maintain muscle. Step three, address insulin resistance at the root cause. That means low car beating, addressing inflammation, and long-form therapeutic fasting protocols, as we discussed. 12 fasts, four or five days out of the week, 16 to 18 hour fast the other two or three days. And that will really help reset and affect insulin resistance at the root. And step four, invariably selective patients, I plan for microdose maintenance in the future if needed for those patients. And the goal is stopping the peptide completely after weight loss is achieved, because I think a lot of patients need some long-term help. So it's graduating to the lowest effective dose while the lifestyle does the heavy lifting. And over time, we can consider withdrawing the peptide altogether, but only after lifestyle dietized and those pillars are taken care of, and the patient has really changed how they are, how they're eating and exercising and how they're handling stress and sleep and so forth. So once the foundation of lifestyle size on basic supplementation is in place and your hormones are optimized, then transitioning off the medication protocol or off the medication maintenance can safely happen and weight gain can be avoided.

SPEAKER_00 48:09

Well, even just listening to that answer, Michael can already start to put together how it's different from or how your approach is different from what they could get or after clicking on the link through an ad online or through an influencer. But tell us more specifically, how does your approach differ then from what people can get?

SPEAKER_01 48:30

Yeah, well, Jamie, the Popkin method uh the is the difference between a product and a system, right? Most online models will focus on the medication alone. They'll follow rigid dose escalation goes on uh trzepatite 2.5 milligrams, they do it for four weeks, then they go up to five milligrams, and they do that for a few weeks, then they go up to 7.5 milligrams. So it's it's that rigid dose escalation that is not necessary. And they also ignore muscle metabolism and sustainability. So you see, most of these standard treatment protocols increase your dose every few weeks until you get to a maximum dose. And that plan was actually developed, Jamie, for clinical trials, not for widespread clinical use. It wasn't designed for long-term patient success. And the lack of weight loss sustainability proves that this is the case. Yet the clinics are reluctant to change a lot of times because obviously they're making money on the medication. So why would they want to not escalate the dose when they make more money by selling more of the medication? Higher doses mean stronger appetite suppression, stronger appetite suppression leads in many cases to severe caloric restriction, which crashes your metabolism, and severe protein malignation, which leads to sarcopenia or muscle wasting. So these are all the things we don't want you to do. A crashed metabolism along with muscle wasting will stall your progress during the treatment program, and it'll cause you to regain the weight when you stop the peptide. So again, the solution is the lowest effective dose is your goal. And enough of the peptide, take enough of the dose to quiet the food chatter, but not so much that attaining your calories becomes impossible. And this is where the popkin method comes in. The popkin method integrates lifestyle, nutrition, exercise training, and supplementation. I utilize peptide stacking strategically, not blindly. I emphasize the lowest effective dose, and most importantly, I create a treatment plan that sustains results in the long term. And in my practice, patients often use 50 to 70% less medication than the standard protocols, and they get better body composition results. They maintain or gain muscle mass. They live fat. And this is important, right? They get rid of visceral fat, which is even more important because that's the dangerous fat we're talking about. And my patients have far less muscle loss and they achieve results that actually last even when they stop taking the GLP1 medications, which is what our that's the intention. We don't want you on these medications for the rest of your life. So this dose escalation trap is pervasive in most other treatment protocols, especially when there's no physician oversight that you commonly see with the Instagram clickbait influence. You just go on a standard protocol that escalates your dose. And the fact is that incorporating all the different aspects of the popkin not only allows you to use the lowest effective dose of the medication, but it also corrects the problems that cause you to gain weight in the first place. And in a lot of cases, if you follow the popkin method, you don't even need to go on the on these peptides. But if you do need the help, you still need to follow all the basics that we talk about. So when you actually come off the medication, your weight loss will be sustained, you will be much healthier because you have lost your appropriate weight, your liver fat will have decreased, your insulin resistance will have corrected. This will affect all your other comorbid conditions if you have any, like hypertension, diabetes, high cholesterol, arthritis, and other weight-related issues, because ultimately the goal isn't just to lose weight, the goal is to correct the physiology that caused the weight gain in the first place. So, in closing, Jamie, if there's one thing I want everyone to take away from this conversation, it's this there's no medicate peptide, no outperforming agical system. GLP1 therapies, peptide stacks, even the most advanced regenerative treatments, there are they're powerful tools, but they're not replacements for the fundamentals. And when those fundamentals are missing, results on muscle is lost, metabolism adapts in the wrong direction, and weight gain becomes almost inevitable. The Popkin method was designed to solve that problem. We build the foundation first. Lifestyle that promotes restorative sleep and stress reduction, nutrition that stabilizes insulin, resistance training that preserves muscle, and strategic thing that restores metabolic flexibility and teaches your body how to burn fat in the fastest state. And core supplementation that supports the system at a cellular level. Then and only then do we layer in advanced therapies. And when we do, we use them differently. We use peptides at the lowest effective dose. We have a focus on body composition, not just your scale weight, and a long-term strategy built around sustainability because the goal is not short-term weight loss. The goal is to correct the physiology that created the problem in the first place so that when you come off the medication, your results are with you. And that's the difference between chasing outcomes and actually building health. So if you found this episode helpful, I encourage you to share it with someone who may also be trying to navigate the complexity of modern health, especially as it pertains to the GLP1 weight loss peptides. I think people today are stuck in what I call the revolving door of treatment plans, seeing multiple specialists, receiving fragmented advice, being bombarded by so-called internet info who offer no real solutions other than purchasing products and never quite developing a strategy that ties everything together. The goal of the Popkin method is to change that. This podcast series is designed not only to educate, but also to help people understand that there is a more structured and integrated way to approach health, one that combines the principles of internal medicine, functional, and regenerative medicine in a thoughtful, coordinated care plan. So if you feel like you're ready to move beyond scattered treatment plans and start building a personalized care strategy to address your weight loss goals, as we discussed today, or any other health concerns you may have, I invite you to start a conversation with me. You can learn more by visiting thepopkinmethod.com, and from there you can schedule a discovery call, a virtual functional medicine consultation, or an in-person caution at my office in Hollywood, Florida. You can also follow along with additional education and updates on my social media platforms and Facebook, Instagram, and LinkedIn. And you can find longer educational content and lectures on my YouTube channel as well. My goal with all of this is simple to help patients understand their physiology, organize their care, and develop a clear path toward better health. So thank you for listening to the Popkin Method podcast, and I'll continue in the conversation in the next episode.

SPEAKER_00 55:04

You don't need more opinions, options, or over certainly don't need your peptides recommended by Instagram influencers with zero credibility and treat site. You need the sequence and structure that the Popkin Method provides. And that starts with one plan that's built to last. So if you're ready to explore these therapies the right way, visit thepopkinmethod.com to learn more and schedule a discovery call, an online consultation, or an in person visit with Dr. Popkin today. This is the Popkin Method, and we will see you next time.