Modern Metabolic Health with Dr. Lindsay Ogle, MD

Foundayo For Obesity Care: The New Oral GLP-1

• Lindsay Ogle, MD

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LillyDirect for Foundayo
Birth Control Options: Website & YouTube 

How to Manage GLP-1 Side Effects

We break down Foundayo (orforglipron), a newly FDA-approved oral non-peptide GLP-1 medication for obesity management, and explain what makes it different from other GLP-1 options. We share how to time it, what side effects to expect, what interactions to watch for, and what the clinical trial data suggests about real-world weight loss and metabolic benefits. 
• what Foundayo is and why the non-peptide oral form changes dosing flexibility 
• how peak effect works and how dosing time can match your hunger and food noise pattern 
• common GLP-1 side effects and practical ways to reduce nausea, constipation, and reflux 
• why CYP3A4 metabolism matters and which medication interactions to flag early 
• oral birth control considerations and when to use backup contraception 
• what to do if you miss a dose and when you must restart at the lowest dose 
• Attain trial results and how Foundayo compares with semaglutide and tirzepatide averages 
• who may benefit most, including needle aversion, frequent travel, weight maintenance, and those wanting a milder option 
• cash pricing overview through LillyDirect and why more options improve obesity care 
If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. 


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Welcome And Medical Disclaimer

Dr. Lindsay Ogle, MD

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you.

What Fondeo Is And Why It’s Different

Dr. Lindsay Ogle, MD

Welcome back. Today I am so excited to talk about the newest FDA-approved obesity management medication, which is Orforglipron or the brand name Foundayo. This is a brand new medication that is recently available, and I'm so excited to review the pros and cons of this medication, review how effective it is in studies, and the type of patients that this medication may be most appropriate for. As an obesity medicine specialist, I know that obesity is a chronic multifactorial disease, which deserves the kind of care and attention and treatment that other chronic diseases have. And for that, we need multiple treatment options. And we've been fortunate enough in the last couple of years to have more of these medication options available. And now and in the next couple of years, there's more and more that are being released. So as they continue to be studied and released, I will provide these summaries so you know what options are available to you and your loved ones. And today we're going to focus on Orforglipron. Again, brand name is Foundayo. So what is this medication? This is an oral non-peptide GLP1 medication. And if you saw my previous video about oral weigovy that's available, that is an oral peptide GLP1 medication. And basically the difference is in how big the molecule is, the active ingredient in the medication. So orfluorgrapron is a very small molecule or a relatively small molecule, which allows it to be more easily absorbed when you consume it orally. So the big benefit here is that you do not have to have specific timing of taking the medication like you do with oral vigobi. You can take it any time of day, you can take it along other medications with food, without food. There's no restrictions on the amount of fluids that you take with it. You could take it anytime, which gives a lot more flexibility with this medication, which is a key positive with orforgepron.

Timing Your Dose For Hunger Control

Dr. Lindsay Ogle, MD

A common question I get with medications is when does it become active in your system? So for Orforglipron , um the peak it takes about four to eight hours to reach the maximum concentration or the peak effectiveness of the medication. So if you take it when you wake up, let's say seven o'clock in the morning, then anywhere between 11 and then maybe 3 p.m. you're gonna have its peak effect. And so you could use this to your advantage to adjust the timing of the medication. If you tend to struggle with excess food noise and hunger later in the day, then maybe you take your medication a little bit later in the morning to cover you around dinner and evening time. But I do recommend being consistent with this medication if you do move forward and start Foundayo that you take it at the same time every day to keep a fairly consistent amount in your system. Having some inconsistency, it's okay, but it could increase your chance of having side effects.

Side Effects And How To Reduce Them

Dr. Lindsay Ogle, MD

And what are the side effects of Foundayo? The side effects are very, very similar to our other GLP1 medications because it acts in a very similar, almost equivalent way, in that it helps control hunger and food noise at the brain level, it stabilizes blood sugar and insulin in response to the food that you're taking in throughout the day, and then it slows the emptying of the stomach so you feel full on less food and for longer periods of time. And the most common side effects are related to that last part: the slowing of the stomach, so nausea, bloating, upset stomach, heartburn, constipation, diarrhea, GI-related side effects are by far the most common for any GLP1 medication, and Fondayo is no different. And there are lots of things that you can do to mitigate these side effects. I talk about this in prior videos and in podcasts, which I will link below so you can take a deeper dive. But the most important things to you know make sure that you are tolerating the medication is you always want to start at the lowest dose and titrate slowly. The fastest we increase the dose is once a month. You also want to make sure you're staying very well hydrated on these medications that can help prevent nausea, fatigue, and constipation. You want to make sure you're eating consistently throughout the day. An empty stomach can trigger nausea for many people. You also want to make sure that you are getting enough fiber and protein and avoiding high amounts of added sugar, greasy foods, really spicy foods, fried foods, those can tend to upset the stomach on GLP1 medications.

Drug Interactions And Liver Metabolism

Dr. Lindsay Ogle, MD

But what is a little bit unique with Foundayo is how it is metabolized in the body. And it gets metabolized through the liver and is considered a cytochrone 3A4 inhibitor. So why this is important is that there are other medications that have that same route of metabolism. And when medications with that similar metabolism are used together, it can cause issues and change the concentration of medications in your body and lead to increased risk of side effects. And so for any medication that you're prescribed or considering taking, including supplements, you want to tell your doctor so they can make sure that there is no interaction happening. So for all medications, that is important, but for Foundayo, it's a little bit more important compared to other GLP1 medication options because of this metabolism. And I want to particularly highlight a few medications that have this similar process and could cause an interaction. So statins, but specifically Simvastatin, that should be used with caution or with dose adjustments with Foundayo. And then possibly you could switch to a different statin, which would not have as much of an interaction. And then some HIV medications to treat and prevent HIV, as well as some antibiotics. So those you definitely want to run by whoever is prescribing your Foundayo, or if you're on Foundayo and going to be prescribed a new medication, just make sure that those interactions are evaluated. But also not a bad idea, bad idea to do for any medication.

Birth Control Absorption And Backup Plans

Dr. Lindsay Ogle, MD

Birth control is also something to consider. So similarly to tirzepatide or zep bound, if you are taking an oral contraception, oral birth control pills, then when you're taking Foundayo you want a backup contraceptive method. So that can be condoms, um, it could be a patch, uh, a ring, um, it could be phexxi, it could be a next one or IUD. Um, you want another form of pregnancy prevention when you start the medication for a month after starting and then a month after increasing your dose. After that, when you're in a steady state, then it is very likely that your oral contraception is being absorbed appropriately and you're getting that um contraception, um, that pregnancy prevention. Um, but I wanted to highlight that because if this is something that is very important to you, then it may be worth considering an alternative birth control option. And I do have um a video about all the birth control options that I will link here as well as my favorite website that goes over the pros and cons of birth control.

Missed Doses And Safe Restart Rules

Dr. Lindsay Ogle, MD

I'll also mention here what to do if you miss a dose. So if you miss one dose of foundayo, then you should just take that dose that you missed as soon as you remembered. But if it has been longer than a week that you have been off of medication. So if that is because you've had a planned surgery or you lost access to the medication, then it is important that after a week of being off of your fondeo, that you start at the lowest dose and then do the titration over again to prevent any serious side effects with restarting at a higher dose. And I'll also add when you do forget your dose, do not double your dose the next day. You do not want to quote unquote make up for the dose that you missed. You just want to kind of get back on track the next day because if you double your dose and you're taking twice as much, and you are likely to have negative GI side effects from that. So just restart the next day, or if you remember later in the day, you could take it later in the day, but do not take two tablets the next day. That would not

Trial Results And Realistic Weight Loss

Dr. Lindsay Ogle, MD

go well. So, what did the study show? The name of the study for Foundayo, or now marketed as Foundayo, was the attain trial. And this was a 72-week trial where patients were given the multiple doses of Foundayo and titrated to the max recommended dose or the max tolerated dose, and then other patients were given placebo. Um and both of those groups they were recommended to reduce their caloric intake and to exercise on a regular basis. So most were given lifestyle recommendations, but one group got the fandeo and then one group got placebo that they were taking each day. And what they found at the end of the 72 weeks was that was that the average weight loss was around 10%, a little bit more than 10%. And I'll break down the numbers based on the dose that the patients in the clinical trial were taking. So those who were taking just a six milligram dose, the average weight loss was seven and a half of their total body weight, seven and a half percent of their total body weight. For those at the 12 milligram dose, it was 8.4% of their starting body weight. Um, and then for those at the max dose of 36 milligrams of orforon, they lost an average of 11.2% of their starting body weight. And again, these are averages, so some lost less, some lost more, um, but that's what the study saw. Compared to those patients who were on the placebo pill, they lost an average of 2.1% of their starting body weight. So they did lose some, but very, very minimal compared to those who are on orflorgopron. And just to remind everybody what averages are for other GLP1 medications to compare, if you're considering your options for trisepatide, that is currently our um, you could say strongest, most effective GLP1 option. That is about an average of 20% total body weight, and then Wegovy is closer to 15 to 17 percent for both the injectable and the oral formulation. Um, so Orforglipron or foundayo is on average a lower body weight percentage loss in the studies, but for some people that may be all that they need, and I will talk about that um in a little bit. But I do want to highlight um that among the patients who were receiving the max dose of 36 milligrams per day, um, about 55% of them, so over half, lost more than 10% of their initial body weight. And that's really important because that 10% total body weight loss from a clinical standpoint, so um, in the eyes of an obesity medicine physician, is very notable because that is where we see many, many health-related outcomes improve. So that's where we see less knee pain from osteoarthritis, we see improvements in blood sugar and cholesterol panels, decreased inflammation, less um fatty liver. We see clinical outcomes improving at about 10% body weight loss. So that is what we are shooting for for clinical improvement. I know many patients have you know other goals, um, but that is really important to note. Um, and then even beyond that amount, um 36% were able to achieve 15% or more total body weight loss. And then there was 18 um percent that lost 20% of their total body um weight um or more. So almost one in five were able to achieve the amount of weight loss that is seen on average for Zepbound. So that just highlights that there's a spectrum of response, and the averages that we see in studies don't always show that. Um, and so there are definitely people who are going to, you know, be hyper-responders of or Orforglipron, um, which is wonderful because this could be a great option for many, many people.

Who Fondeo Fits Best

Dr. Lindsay Ogle, MD

So, who might it be a good option for? It's a great option for anybody who has a fear of needles. Um, so we want an oral option. Um, we have oral wegovy and we have our Orforglipron or foundayo um for oral GLP1 medications now. Um, it could be also helpful for anybody who does not have consistent refrigerator access or travels frequently for work or for pleasure. This does not need to be refrigerated. It is also a good idea for somebody who is worried about the environmental impact of, you know, a high utilization of the auto injectors because that takes a lot more plastic and packaging and to deliver to patients. And so oral medication and a typical pill bottle has less packaging, um, so could be more environmentally friendly. It's also a really great option for patients who maybe do not need to lose 20% of their total body weight loss. So somebody who maybe fits in the overweight category or what we call class one obesity with a BMI in the low 30s and they are earlier on in their disease progression, this could be a great first option to control weight and obesity before it gets to later stages and would need more intense treatment. It's also a really good option if you have tried Zepbound or Wegovy in the past and it was just too strong for you. It was suppressing your appetite to the point it was difficult to eat, you had zero food noise and actually were not enjoying food anymore. This could be a good option for a more mild effect. So something to consider. It also because of the shorter half-life, it is something that could be a good option for somebody who is nervous about the side effects or maybe has severe side effects on an injectable GLP1 in the past and are wanting to maybe try again, but want something again, maybe not as strong, or they could try this and see how they respond. And if they are having those negative side effects, you can stop it right away. You don't have to take that next day's dose, and it will um go through your system much faster than an injectable. And then another category that is being talked about a lot is weight maintenance. So if you have been on Zepbound or Wegovy or maybe had a metabolic and bariatric surgery in the past and are looking for something for weight maintenance that's gonna be able to help control food noise and appetite and cravings and increase fullness, um, but maybe you don't mean to again lose a really significant amount of weight and you're just looking to maintain or Orforglipron or foundayo, this could be a great option in those cases and maybe a more affordable option for your maintenance.

Cost Options Plus Key Takeaways

Dr. Lindsay Ogle, MD

So, what is the cost? Um, of course, insurance coverage is going to vary from plan to plan, and so I'm not necessarily going to get into that. Um, but if you do not have insurance coverage, then the best way to get Foundayo at this time is through LilyDirect and their program. You can get the starting dose for a month supply $149, and then the next dose would be $199, and then the doses after that would be $299 per month. And this is the same price as Oral Week will be, and it is less expensive than the injectable GLP1 medication options for cash pay. Um, so I will include a link where you can you know look into Lily Direct's program a little bit more and see if that might be a good option for you. Alright, so that is my overview of Foundayo our newest GLP1 medication, our newest obesity management medication option. The key takeaways are it's an oral non-peptide GLP1 medication, so it is more easily absorbed in your GI tract and can be taken at any time with food and or medications. It works in a similar way as other GLP1 medications, so it has a similar risk-benefit profile, but has a few drug-drug interactions to be aware of. And anyone who is on an oral birth control should have backrub contraception when starting and titrating Foundayo. Average total body weight loss is around 10 to 11%, but there are many patients who achieve 15, 20, or more percent total body weight loss on the medication. There are many people who this could be a great option for, and the most exciting thing about this is that we are continuing to have more treatment options for the treatment of obesity. So I'm so excited to be in this field of medicine and have even more options to help my patients now and in the future. Do you know anyone on Orforglipron Foundayo? Is this something that you're considering? Do you still have any questions about this medication? Please let me know. If you're on YouTube, you can put it in the comments below. Or if you would like, you could send me an email at support at Missouri Metabolic Health.com or reach out to me on TikTok or Instagram. I would be happy to answer your questions. And I hope you all have a wonderful week. Talk to you next Monday. Thank you for listening and leaving how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous. misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.