The Better Body Lab Podcast
The Better Body Lab Podcast explores how science and lived experience intersect within the human ecology. Hosted by best-selling authors Dr. Taryn Marie and Mike Alden, each conversation brings together physicians, researchers, and wellness thought leaders to examine how we adapt, recover, and grow stronger—physically, mentally, and emotionally—in a complex world.
The Better Body Lab Podcast
Pills vs. Needles: The New Frontier in Weight Loss and Hormone Therapy
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What if the future of weight loss and metabolic health isn’t just about new medications — but about access, personalization, and how the body adapts over time? In this episode of The Better Body Lab Podcast, we sit down with endocrinologist and obesity medicine specialist Dr. Rekha Kumar to explore the evolving science of GLP-1 therapies, hormone health, and sustainable health optimization.
Together, we examine how resilience, recovery, and performance are shaped within the “human ecology” of metabolism — where biology, mindset, environment, and daily habits intersect. We unpack the shift from injectable to oral GLP-1 medications, challenges around affordability and off-label prescribing, and how new delivery technologies may expand treatment access.
We also explore key drivers of metabolic dysfunction, including hormonal transitions, insulin resistance, and muscle loss, along with practical insights on microdosing strategies. Ultimately, we discuss how individualized, evidence-based care can support long-term vitality and performance resilience.
About Dr. Rekha Kumar:
Dr. Rekha Kumar is an internationally recognized leader in Obesity Medicine and serves as Senior Medical Advisor at Found, advancing personalized, technology-enabled weight management. She also practices endocrinology at New York-Presbyterian, helping bridge traditional care with digital health innovation. She is triple board-certified and serves on the advisory board of the Duke Global Health Institute.
Follow Dr. Kumar here:
LinkedIn: https://www.linkedin.com/in/rekha-kumar-m-d-m-s-70b481237/
Instagram: https://www.instagram.com/drrekhakumar/
For information about Found visit: https://joinfound.com/
Key Timestamps:
00:00 GLP-1 microdosing & prescribing realities
02:33 Shift toward oral GLP-1 therapies
13:01 How oral delivery technology works
23:01 Benefits beyond weight loss
36:20 Hormone therapy considerations for women
50:22 Metabolic health stigma & bias
55:21 Muscle mass, glucose metabolism & performance
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TikTok: https://www.tiktok.com/@thebetterbodylabpodcast
Dr. Taryn Marie: www.resilience-leadership.com/
Mike Alden: https://www.mikealden.com/
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Facebook: https://www.facebook.com/MikeAlden2012
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If someone just wants to just quote microdose as we just talked about, right? Um how does this how does a prescription get written for that? Because I'm seeing like a lot of pushback uh in the in in the from between the uh prescriber uh and and you know and the pharmacist in charge or these different pharmacies. How does that work?
SPEAKER_05You you can't really write a prescription for off-label prescribing because a pharmacist isn't gonna dispense it. They have their own responsibility to stick to FDA guidelines. But say you want to microdose them. Maybe you say to someone, I'm gonna write you for the lowest dose pen, 0.25 milligrams weekly. I only want you to do 10 clicks. That will get you halfway to the lowest dose. I can't write the prescription like that because it's off-label use, and there's no way to write it like that. But this isn't anything like sketchy. So think about prescribing.
SPEAKER_01Yeah, it's within, yeah.
SPEAKER_05Right for women. We can't even say I wanted to prescribe testosterone for women, which I do.
SPEAKER_01Right.
SPEAKER_05There's no way to write it. I have to write it as if I'm writing it for a man. So I prescribe air.
SPEAKER_02Oh, wait, wait, hold on. Pause for a second.
SPEAKER_05Yeah.
SPEAKER_02Wait, back up. Backup. Okay, so if you want to write a prescription for testosterone for a woman, you have to write it as if it's a man. Like, back up. Tell me more. I I can hear more.
SPEAKER_03Hey everyone! We are so excited that you are joining us for another episode of the Better Body Lab Podcast. And today we have an incredible guest for you, Dr. Rega Kumar, who's the senior medical advisor for a company called Found. Maybe you've heard of them. They're doing incredible work in health optimization and weight loss. And I think what's really exciting, and one of the reasons that we're so excited to have you on today, Dr. Kumar, is because we've been talking a lot about moving from an injectable formulation of GLP1s to an oral formulation of GLP1s. And one of the things that you said that I think is just so apt for us right now is that 2026 is likely one of the most important years as we think about the impact and the uptake of people who are taking GLP1s for weight loss. So we're really moving from, you know, what's next to actually what's here right now. And so where I'd love to start is this idea between injectable GLP1s and oral GLP1s. Um, why does this shift toward offering an oral GLP1, why does that matter so much in the marketplace and also to the people taking this medication?
SPEAKER_05Yeah, so thanks for the introduction and for having me. I do think 2026 is probably the biggest year yet for GLPs with the introduction of oral WeGovi. And the fact that there's an oral really democratizes the access to a medication that has now been shown to have so many health benefits. And what the oral does is that it gives people who are GLP1 curious because of those other health benefits that maybe don't have as much weight to lose. It gives them an opportunity to try it without the commitment of an injection, without something that feels so medical and serious, even though we're comfortable with the injection. Injections are associated with more serious conditions, diabetes, chemotherapy, like the things that we associate needles and injections with are serious medical conditions. I'd say there's a spectrum of interest amongst people who want to use GLP1s. There are people that legitimately meet the FDA criteria of obesity or type 2 diabetes, but now we're seeing a whole world of prevention, health optimization, PCOS, perimenopause, all these other conditions that may benefit, but the idea of an injection that's so long-lasting may feel like too much.
SPEAKER_03I love that. You know, one question that I think a lot of people are asking themselves is Am I a fit to take GLP ones? You know, I think you lightly touched on this idea that um we're thinking about GLP1s not just as a medication or a drug specifically for weight loss or significant weight loss. So for someone who's listening to this podcast right now, what kinds of things would they be looking at within themselves or within their body to say, you know what, I might want to consider either an injectable GLP1 or an oral GLP1.
SPEAKER_05I would think about whether a person has done what they are willing to do on the lifestyle side or capable of doing. And again, I would never expect anyone, my patients, to be perfect with nutrition and exercise because that's not realistic. But if you are doing the best you can 80% of the time, in terms of making the right food choices, moving your body, paying attention to quality sleep and managing your stress. And despite that, perhaps your doctor has said, your blood sugar's going up, your cholesterol's going up, or a woman in her midlife saying, you know what, my pants are tight, I'm doing everything right, I haven't done anything differently. I mean, those may all be these subtle reasons that you are GLP1 curious, but maybe your primary care doctor doesn't feel comfortable giving you the medicine because you don't meet weight criteria. People know that insurance isn't going to cover this. And so it would take a lot of hoops to jump through to access the injection, possibly. So now that there's an oral, it's hard to separate it from the price, too. With the coupon, it's fairly inexpensive. And so there is this um opportunity now to try something that may be helpful if you feel like you've maxed out on realistically what you can do on the lifestyle side.
SPEAKER_02You know, we're big fans of of access. Uh, Tara and I talk a lot about access, um, both kind of kind of how we grew up and you know, our and when we were young, we didn't necessarily have access to a lot of things. Um when I heard you talk earlier before we started recording, when I think of access on a fundamental level, of can I get it, right? You know, can is it is it available, right? So we had the shortage right before. And I the way you were describing it, I think earlier, the access part of it, there was it's more to it than actual availability, right? Kind of if you could expand on that a little bit about what you mean, you know, on a global perspective from access.
SPEAKER_05Yeah. So I think the word access is thrown around a lot when we talk about health equity and being able to get medicine, either because of where you live, the cost of the medicine, whether you have private insurance or cash pay or a government plan. But really, access incorporates, I think, three concepts. It's uh price, convenience, and speed. So can you afford this? Can you actually get this within your hands amount of time, right? Who wants to wait like four weeks for a prior off when someone is motivated to do something? And the other is is there a convenient way to get this? Do you have to drive to a pharmacy 50 miles away? There were people during the shortages that were, you know, driving to pharmacies out of state and even flying to countries to buy their GLPs. So I'd say like price, speed, and convenience all fall under the definition of access. And I know people that had, you know, plenty of money to buy GLPs out of pocket during the shortage, but it was so inconvenient that they just gave up. They were like, I can't be on the phone with this telehealth company or this insurance, like wherever for two hours on hold. And some of those were wealthy people, and they were like, I'm just not doing this. So price, speed, and convenience are all parts of accessing care and medicine.
SPEAKER_02Well, I think what I was trying to get at is you were talking about the pill itself, right? And the implication of an injection. I don't know, I don't know if we were recording on that part or not, but you're talking about the implication of an injection, like really what that means, you know, to a lot of people, it usually has this feeling of, you know, some sort of um, you know, maybe uh, you know, terminal disease or or long-term disease. So therefore, we don't access it because maybe from a psychological standpoint, that's what I was, that's what I was trying to get to.
SPEAKER_00Sorry, yeah.
SPEAKER_02No, don't be sorry. No, no, like I listen, we were gonna get there no matter what. That's okay. But I thought it was a very valid point.
SPEAKER_03I just want to say I love the price, speed, and convenience element. And I have ADHD, and so Adderall is often in short supply. And I have been a girl who's driven to all kinds of you know, obscure pharmacies or sent Mike to pick up the medication with my ID, you know, to get, you know, Adderall in like a you know a 30 mile radius. So we completely get it. Um, and Mike, I love where you're going with this too, kind of like as a next level to say, okay, there's the you know, access affordability, you know, price, speed, convenience element, but then there's the psychological element of how does it make me feel to be injecting something in my body and what meaning do I start to make of that? So I'll turn that back to you, Dr. Rika.
SPEAKER_05Yeah, there's like a very uh medicalized connotation of injecting yourself, as there should be. That's a serious thing. I it's becoming more mainstream, it's becoming more mainstream with GLPs to peptides to so many people doing fertility treatments. But I will say that for the average person, the concept of an injection can mean you're crossing into the lines of something very medical, scientific, something that carries more risk. Way back in the day, over 10 to 15 years ago, when we were prescribing GLP1s for weight before anybody knew about this, our patients were terrified. When we had like off-label Victosa or Liraglitide, even when Saxenda was FDA approved in 2014, and we would want to put people on it, people would say, Oh my gosh, am I starting insulin? And these and that was like the first thought people had. And so, in terms of the the way we're using the word access right now, is that the pill versus the injection allows for an access that might be more comfortable to people to try something. People swallow pills when they have a headache, they take supplements. So, not to minimize the scientific rigor of the pill, but it makes people more comfortable than an injection.
SPEAKER_02Yeah, yeah. That's what I always get. I mean, I've uh always been, you know, afraid of needles. Uh I don't know, I've passed out a few times, given blood, so maybe that's it. Um, but I think that makes a lot a lot of sense. A lot of people are, you know, I've I've had I've I listen, I have family members that are that are more than medically obese, you know, uh, and they're like, I'm not injecting myself with that stuff, just not gonna do it. But as you said, culturally, we're so accustomed to we got a headache, we're gonna take a pill, supplement, we're gonna, you know, we're we're gonna take a pill. Um, so it's just just you know, kind of easier for them. Um, I'd like to jump into now the pill itself that we're talking about. But before we go into that actual pill itself, my understanding generally, again, I'm not a doctor, you are, but you know, the gold standard for efficacy as it relates to a pharmaceutical drug is is an injectable because of the way that the body absorbs it, right? Um, and then, you know, when you think of uh pills as well, and and the you know, the GI tract has to go through, it has to go through that. By the time it actually gets into the bloodstream or it gets to where it's supposed to go, it's it's diluted, it's not as efficacious, and then the impact on your liver and your kidneys. So I'd love to hear more about just maybe kind of the delivery system first and then the pill itself.
SPEAKER_05Yeah, so this thought that like injections are always better than pills, I wouldn't say is necessarily true. It depends on what the chemical structure of the medicine is. So the reason that GLP1s have been injectable is because they're peptides. And that's something that's important to recognize. So they are a sequence of amino acids that make up a peptide, which peptide is a simple name for something that builds up to be a protein. The reason this is important is our stomach is designed to break down proteins. We have enzymes, when peptides are proteins, hit our stomach, these things are broken down so they can be digested and absorbed. And so if something's not a peptide, if it's a small molecule, if it's something else, there's no issue with making that oral, right? We don't inject Tylenol, we don't inject Advil. We take those by mouth because they are uh broken down to an absorbable size that is still effective. Whereas a peptide had to be injected because historically stomach acid would have destroyed the peptide and made it ineffective. So the way they made this pill effective is by creating something called snack technology, S N A C. And you could look up what that stands for. It's a long name. Um, I actually made an Instagram video about snack, it's super nerdy and I we love snacks.
SPEAKER_02Wait, what? What are we talking about again?
SPEAKER_03Um anyway, we thought we were supposed to take this pill so we didn't have snack.
SPEAKER_05This this snack uh is literally the technology that has allowed novonordisk to turn this peptide into something that is able to uh be resilient despite stomach acid. So the snack technology creates a buffer around the pill when it's in your stomach, meaning that it buffers the pH so it's not broken down, just around the pill in a local environment. And then it almost acts as like a little elevator to push the pill through the stomach lining. So not only is it not broken down, it's pushed across the stomach lining into the bloodstream. Before we had an injection because we needed to find a way to get the peptide into the bloodstream without breaking down through stomach acid. Now we're saying, hey, swallow the pill. It's coated by snack. Snack will buffer the stomach pH and push it across the stomach lining. And that's what's new.
SPEAKER_02Okay, so uh earlier, but this is definitely before we were recording, you know, I come from the supplement space and I've seen all sorts of different delivery systems. Um, I've seen a lot of you know time release technology, uh, different coding on whether it be uh uh you know a capsule or a pill or a tablet. And you know, a lot of it has to deal with time release. And, you know, when I hear about this pill, um, one of the things that I heard, maybe you can help me here, one of the things I heard is that it almost like, for lack of a better term, it hooks into the GI track. Um, could you explain that? Is that accurate?
SPEAKER_05Yeah, that's an interesting way to think about it. Basically, it it uh pulls it towards the stomach lining. So you could you could call that a hook. I called it an elevator to like push it. Um, but basically, in addition to protecting the pH around it to prevent degradation, we also need to push it over the stomach lining so it gets absorbed. And so, yes, not only is there the buffer, but there's sort of a hook or um a pull.
SPEAKER_02Okay. So, so because that's the part when I when I understand, you know, uh delivery systems and time release, these coatings, to me, that technology seems fairly, you know, simple and and nothing really super special, but I know this bunch of patents on different ways. But this pill, when I heard how this works, you're using the elevator analogy, I'm using the hook analogy. Basically, we're it's getting it's getting to the place where it needs to go before it breaks down, right? So, um how does it do that?
SPEAKER_05So the way how does it act as an elevator or yeah, how does how does how does it know?
SPEAKER_02Like how does it how does it, you know, how does the how does the GI track, how does the stomach lining know where to get this pill to the right place before it breaks down?
SPEAKER_03Like this is such a this is such a like a like a funny question. It I know someone remember we actually don't want it to break down.
SPEAKER_02So I know that's what I'm saying. That's what I'm saying. I'm saying, how does it get to the place before it needs before it, how does it get to the place where it needs to go, right? So then it can ultimately deliver the semaglytide. Like, how does it know where to go, right?
SPEAKER_05So actually And I don't know why this is funny, Taryn.
SPEAKER_02I can't wait to hear why this is funny.
SPEAKER_05Yeah, there's only one place to go, actually. So if something um is intact in your stomach, it could keep being passed through, I guess. It could go into the small intestine, but it will interact with the the stomach lining. And then the the stomach lining is dense with capillaries, so that's a way to get this immediately into the bloodstream right from the stomach wall. So exactly like how and why, I I I can't say that I totally know the science there, but um you there's two steps here. There's preventing it from breaking down, and then fully intact the semaglotide needs to go through the stomach lining into capillaries, that then that's where you want it, right? That then you've reached the stage because when you inject it into subcutaneous tissue, the way it's absorbed is through small capillaries. Okay. So once it's hit the stomach lining, you're good.
SPEAKER_02That's why, that's why I've I I've I've actually talked to a couple of doctors in this space, and they're the ones that gave me the hook analogy. And that's the part that like makes sense to me. If I can visualize it, you know, you literally swallow a pill, goes down the esophagus, get gets into the stomach, and then it it stays where it needs to stay, basically. That's how I understand it. Um, does that make sense?
SPEAKER_05Yes.
SPEAKER_02Okay.
SPEAKER_05It's it stays temporarily, but then it gets absorbed.
SPEAKER_01Right.
SPEAKER_05Yeah.
SPEAKER_01Okay.
SPEAKER_05And then then you're basically at the stage as if you injected it.
SPEAKER_01Right. Okay.
SPEAKER_05I think it's a probably the one key thing that we're honing in on here is our small capillaries that have access to the bloodstream. Right. So even when we inject this, we're injecting it so superficially. These are tiny needles, right? They're just going under the skin. But but these things are going into the bloodstream because they're going through these tiny, tiny capillaries that are offshoots of our bigger vessels. And the same with the stomach lining.
SPEAKER_02Taryn, what now what was uh I want I can't wait to hear my humor here.
SPEAKER_03Well, I'm just thinking about how you and I joke around sometimes and we're like, how it be? How it works.
SPEAKER_02I was thinking the same thing. Yeah. How would no, you know, because I was I what I was thinking like nanobots, you know, like like or like you know, you hear like nano nanotechnology, or everyone loves to talk about, you know, but uh for me to understand it, I think, you know, you the way you explained it makes sense too, but I it's just easier for me if the way because that's just the way I heard about it, and that makes total sense because that's why I was saying, like, I have a lot, you know, 20 years uh of understanding of mostly supplements and delivery systems, and we're always trying to, you know, why is this one better? You know, okay, uh, you know, we have uh, you know, uh, let's say um, you know, vitamin D or whatever, you know, and we want it to absorb better, you know. Well, oh, ours is coated with this special stuff and it gets in, you know what I mean? Um, when I hear about this technology, to me, it doesn't sound that new, but the part where it stays where it needs to stay, that's the part that's important. Next question that I have for you as it relates to that, um, I've also heard that um, you know, uh there's a protocol that people need to do uh on a daily basis or is it a weekly basis on what they can and can't do uh to uh ensure the efficacy of this.
SPEAKER_05Yeah, there's some more stipulations around swallowing the pill than there are with the Injection. So the injection's easy because it doesn't day, time of day doesn't matter. None of that really matters because you're putting it right into the capillaries, basically. And so it goes right to the bloodstream. So in order for this system that we just described, the hook, the elevator, the buffering of the pill, in order for all of that to work, there are some rules around what you can and can't do. So typically, in order for the snack technology to work, you want to take this on an empty stomach with only a few sips of water and wait 30 at least 30 minutes to eat because you don't want to push it. Push it. You don't want to interfere with the pH regulation of what is supposed to happen. And for some people, that works. For others who take a lot of other medicines, people that take thyroid hormone that has its like own stipulations, those people may prefer an injection, actually.
SPEAKER_03Interesting. Um I think we're starting to hear more about what GLP1s can do for all of us beyond weight loss. And I'm curious, what else can GLP ones help people with? Maybe that's medically, physically, mentally, that even goes beyond weight loss.
SPEAKER_05So I've been talking about this diagram I saw that is really cool. And it's that of an iceberg. And you know you have an iceberg that's floating in water, and most of the iceberg is underwater, and then there's a piece you can see above. I saw this diagram about GLP1s, and on top of the water on the iceberg, it says weight loss blood sugar. So that is the outward things that you see. You see, you see the diabetes management, you see the weight loss under the water, where most of the iceberg was, there were words such as cardioprotective, anti-cancer, um, preventing inflammation, brain health, all of the other benefits. So I almost feel like when a patient or a person wants to be on a GLP for weight, I'm like, that you're barely touching the surface. Like we are doing this for so many other reasons. And those are all of the reasons that are under the water in that bottom part of the iceberg, which are all of the other health benefits, reducing the risk of heart attack, stroke, cardiovascular death, optimizing fertility, treating fatty liver, treating sleep apnea. Some of these are weight related, but but others are acting on inflammation independently. And so there are many reasons that someone would want to take a GLP1. There are many reasons now having a pill may make someone more comfortable if they don't need that outward manifestation. If somebody doesn't need to lose weight and they don't have diabetes, but what if they want brain health and heart health and liver health and what if they want all those things? Maybe taking a pill makes sense. And again, we're talking about off-label indications. It would take forever to get an FDA indication on all of these things, but we are learning from the science that there are so many benefits beyond just weight loss and blood sugar control.
SPEAKER_02Could you, could you just give us a we had someone else on and she said she does uh a great job of explaining things uh on an eighth grade, well, they said the New York Times eighth grade level, she was, I think, a fourth grade teacher at one point. She said she she could explain. I said, could you explain it to me in a second grade level? Could you explain uh for our viewers and listeners, you know, what off-label prescribing is uh and why that's important uh as a as a doctor?
SPEAKER_05Sure. So let's start with on-label prescribing. When we prescribe something on label or as per FDA label, that means that we're prescribing a medication for the indication that it was tested and FDA approved. So not only does that mean that you are prescribing a GLP1 only for diabetes management or for a BMI over 30 or 27 or greater with a weight-related medical complication, but you're also on label prescribing means you're prescribing to the population that was intended to be prescribed. So in medicine, off-label means when you leave those categories at all, you're prescribing to a person that doesn't meet that criteria. So for example, there before these medicines were FDA approved for children or adolescents. Now some of them are FDA approved starting age 10, starting age 12. Prior to that, prescribing to somebody under 18 was off label use. You're prescribing to a person that the FDA didn't say on their label, this is who it's for. Or for years, I prescribed GLP1s for PCOS, polycystic ovarian syndrome. That is not an FDA indication. It's accepted science that it's effective, but it is considered off-label use because the label on the drug doesn't say this is indicated for polycystic ovarian syndrome because that's not what it was studied for.
SPEAKER_02And what are the implications for you as a doctor and the patient as well? Uh, are there additional, I don't know, um, warnings that you need to uh let your uh patient know about? Um, because because sometimes when I hear off label, I mean, I feel, I mean, I kind of understand it. I feel like it almost has like a negative connotation, like, oh, that's that's for off-label, you know.
SPEAKER_05Yeah, I mean, I think that it could be a negative connotation when you think of like access, cost, and coverage. So when you're prescribing something off label, especially especially something expensive that's off label, it's not gonna be covered. And that that is a big conversation with GLPs. There's a lot of people that want to try these medicines that are appropriate for them and the benefit outweighs the risk, but we still have to say, because it's off label, I can't pass this through your insurance. I can try, but it'll get denied, and we're gonna have to go with cash pay option. So I would say that it is relevant and can be negative because it makes things more expensive when people want to use their insurance. And the other thing with off-label use is that I do think it requires a risk versus benefit conversation with a patient. Hey, this isn't what this was intended for, but I have a lot of experience doing this. In you, I think that the benefit outweighs the risk and we should try it. Or you may say, in you, I think the risk outweighs the benefit and I don't think we should do this. So those are the kinds of conversations that clinicians and patients should be having when something is off label. And God forbid someone gets hurt. Say there's a serious side effect, and then the patient learns that somewhere else that drug wasn't for PCOS. That drug wasn't for you because you don't meet criteria. Then the patient can come back and be like, well, you never told me that. So you want to really have all of this out there beforehand.
SPEAKER_03You know, um, switching gears for just a moment, um, as I sort of cruise by the Reddit threads on GLP1s, a common thing that a lot of people are writing in about is the fact that they've gotten a GLP one, they've gotten an injectable, uh, semi semi glutide, um, semiglutide, uh, people pronounce that different ways.
SPEAKER_00SEMA.
SPEAKER_03SEMA, um, interzepatide. Um, maybe they have the injectable, maybe they have the pill. And so then they say, okay, I started taking my GLP1 and nothing has happened. Some significant amount of time has gone by, and I'm not losing any weight. How should people think about what to do next if that's the case for them?
SPEAKER_05So in each of these cases, it it should be individualized. So there are people that may not see an effect on the initial doses. There are people that might see too much of an effect, their appetite is too suppressed, they're nauseous. So, this is where I would go back to the clinician, go back to the prescriber of the medicine, and either say, hey, this is too strong or this is too weak. I think administration technique should be reviewed. Are you injecting this properly? Are you swallowing the pill properly? Are you separating out other food? Are you drinking too much water? So you should go over the administration technique and then adjust the dose. Sometimes you may need to switch from SEMA to Terzy in the future to Retta. So I think that there's going to be different people of different profiles that we're able to hone in on in the future that which GLP is better for one person versus the other, what dosing schedule. But we always want to start gentle. We we'd rather have somebody say, Hey, I haven't noticed anything, but I'm okay. I'm not having a side effect, versus someone saying, you know, I've been vomiting for three days straight.
SPEAKER_03Yeah, that's that's so tough. You know, one of the things I love about found and the work that you're doing there is really how much of a stance you've taken on personalizing the approach to metabolic health, um, obesity, and even kind of a broader suite of health optimization and longevity. One of the things that you've talked about sort of in line with that personalization is this idea of microdosing. And I think microdosing is still really new for a lot of people. Could you tell us more about what microdosing is and what that might look like relative to GLP1s?
SPEAKER_05So microdosing has become a very trendy word. And we've been microdosing GLP ones for probably 15 years. But all that means is using lower doses, not necessarily titrating or increasing up to higher doses. Sometimes it means taking them on a different schedule than weekly. So whereas the prescribing uh indication or prescribing pattern is typically weekly. There are people that may take it every other week. I have menopausal women that are taking one dose a month just to keep their metabolisms in check. So the thing is, this has to be very individualized. So microdosing could mean many things. It could mean staying on a very low dose. It could mean using less than the lowest FDA prescribed dose. It could mean spacing it out more than weekly. And what's going to be really fun is microdosing with the pill. Like, what about people that want to do one every other day? Like these are all the kinds of things that we can personalize and individualize. And this is what we've always done at Found. Found existed before the FDA approval of Weigovi. We were personalizing metabolic care to the old school generics that have been prescribed in obesity medicine for decades. And many people didn't even know that we prescribed meds before GLP1s, but we actually did. And we use something called metabolic print at Found, where we create a personal fingerprint based on a bunch of intake data on what somebody's eating patterns, genetics, and on how we think they'll respond to meds. Their metabolic print or fingerprint acts as a blueprint for our doctors to choose a mix of medicines. It's a little different now because GLP ones have become the go-to medicine. But even with GLPs, there's a way to personalize treatment.
SPEAKER_02I have a question about it. Um as it relates just the mechanics of it. So um, so let's say uh some aglatide. Um by the way, the dosing I'm about to say is probably not accurate, but let's let's say um, you know, the average dose is um, you know, 15 milligrams or something, that they that they that's that's the starter dose, right? And let's say that that's the that that's the starting, and if they tie it right up, they double, what have you. Um if someone just wants to just quote microdose, as we just talked about, right? Um how does this how does a prescription get written for that? Because I'm seeing like a lot of pushback uh in the in in the from between the uh prescriber uh and and you know and the pharmacist in charge or at these different pharmacies. How does that work?
SPEAKER_05So I'll I'll make an interesting analogy. You you can't really write a prescription for off-label prescribing because a pharmacist isn't gonna dispense it. They have their own responsibility to stick to FDA guidelines. So, for example, take the Ozempic or Samaglitide starting dose pen. The doses that are marked that it delivers are 0.25 milligrams and 0.5 milligrams.
SPEAKER_00Okay.
SPEAKER_05In order to get to 0.25, the first marked dose, it takes 19 clicks or 20 clicks to get there. But say you want to microdose them. Maybe you say to someone, I'm gonna write you for the lowest dose pen, 0.25 milligrams weekly. I only want you to do 10 clicks. That will get you halfway to the lowest dose. I can't write the prescription like that because it's off label use, and there's no way to write it like that. But this isn't anything like sketchy. So think about prescribing.
SPEAKER_01Permissible, you're within it's within, yeah.
SPEAKER_05Right for women. We can't even say I wanted to prescribe testosterone for women, which I do, right? There's no way to write it. I have to write it as if I'm writing it for a man.
SPEAKER_02Okay, hold on a second here. So you what back up. So you just said if you need to write a prescription for testosterone for a woman, you have to write it as if she's a man, which is so much so confusing. And for those who are listening and watching right now, um, you know, the the world of testosterone has really opened up for women. Uh the black box warning has changed, which is great for women because turns out, and I think everybody knew this, um, that you know, certain levels of testosterone are certainly uh beneficial for women. But tell me what you mean by that, and how do you navigate writing a prescription for a woman in a way that should be written for a man? That's so confusing to me.
SPEAKER_05Yeah, well, there is no FDA-approved testosterone formulation for a woman. So we've been prescribing androgel, which is comes in a pump, to men when they have testosterone deficiency or want to take testosterone. The prescription for a man is the number of pumps they should take of the gel. For a woman, the prescription, there's being that there's no different formulation, I prescribe androgel, which is the formulation for men that come the smallest denomination that you could squirt out as a pump. But I'm trying to get a woman to take a pea sized amount. But I can't write that on the prescription. I can't say take a pea-sized amount. So I have to write it as take one or two pumps a day, but I say to the patient, the prescription is going to say one to two pumps a day, but you are gonna take the size of the top of your pinky. And because if I try to write it as, you know, a fraction of that, it doesn't get dispensed. The pharmacist will say, this doesn't, this isn't a thing.
SPEAKER_02Yeah. Wow, that's um that's crazy. Um, since we're talking a little bit about testosterone and the gel, um, you know, there's there's a lot of different ways right now that that people can take testosterone. There are even pills out there. Uh, we actually know of a company that's that's selling the pills, and allegedly it's it's you know not that um uh destructive on your liver. Uh, you know, so you have uh you know patches that I've that I've seen now that are that are that are really kind of um you know kind of gaining some traction. Um so the gel though, right, for women is problematic, right? Uh for for for a few things, right? If they especially if they're handling their children, right? You don't want the um uh what about an injection of of of testosterone for me? And by the way, I also know it's just for again for our viewers and listeners, this is I mean it's not new, right? But it's relatively new within the general public because now, right, a lot of people are saying, okay, now because the black box warning has been removed, right? We're now it's starting to become more and more popular, so to speak. But why not an injection for it instead of the show?
SPEAKER_05Yeah, and I guess just to clarify, the black box warning on estrogen was removed, which has sort of opened this whole world of HRT or hormone replacement therapy up. And people not only want to replace their estrogen, but we may occasionally give women testosterone for libido for maintaining muscle health. So there's many reasons for it. Um I think what your question was uh what was the original question?
SPEAKER_02Well, yeah, so why it's because the gel, right?
SPEAKER_05Oh yeah. So what could women inject it?
SPEAKER_01That right. Right.
SPEAKER_05I mean, uh again, all there's no formulation of testosterone that injectable that we can prescribe in a regular pharmacy for a woman. So all of this, if we wanted to do it, would have to go through a compounding pharmacy.
SPEAKER_02Right. Okay.
unknownOkay.
SPEAKER_02All right. And and since we're talking a little bit about just your um, so you do prescribe it. Um, when do you prescribe testosterone for women? Like when do you see it's it's good for them?
SPEAKER_05Yeah, so it's again, just like GLP1s, very individualized. When we are treating someone for perimenopause or menopause with hormone replacement therapy, and I normally go for like the estrogen and progenitor first, but if despite that, they're complaining of low libido, fatigue. Uh, we can add in small amounts of testosterone. It doesn't work for everyone. I think if people notice an improvement, we do it. But if they don't, I wouldn't necessarily always keep jacking up the dose because I've seen women that have gotten high doses of injections, pellets, and their levels are really high. They feel agitated. Some women I've seen complain of growing hair on their face when the dosing isn't right. So I think we just again have to go super individualized, personalized, and start slow.
SPEAKER_02Is there, is there, I mean, obviously there's, you know, with men, you have to have a blood test to see where your levels are at, you know, um, your different levels and different types of testosterone, GH levels as well. Um for women, um what what is the biomark? Like, what's low testosterone form? I don't know the, I don't know what the scale looks like for women. What like what's considered low and why would they, you know, want that the testosterone?
SPEAKER_05Yeah, the the problem with testing hormones in women is that like there's not necessarily like absolute numbers and the ranges are so wide. So, what I would do in these cases is get a baseline, monitor it, and monitor symptoms. So see if you're actually creating a difference with the dose you're giving in the formulation you're giving it, and are they getting better? I think if if the numbers are slightly going up from their baseline and they're reporting an improvement, then that's great. If the numbers aren't budging and they're not really saying they notice a difference, maybe go higher. Say the numbers are going through the roof and they don't feel good, then you stop it. It's it's not it's not for them. So I do think you have to monitor the numbers, but I don't think that there's like an absolute right or wrong for each person because so much of this is the way hormones oppose each other, right? So why do women um occasionally say that they develop like a one annoying chin hair through perimenopause? Is it that they're like absolute testosterone is always higher? Not necessarily. It's the way estrogen and testosterone oppose each other. And as estrogen declines through perimenopause and menopause, the testosterone's more active. It's it's not that the level is necessarily, you know, so high. Someone could have a certain level of testosterone, complain of low libido, but still complain of like, you know, hormonal pattern baldness and the annoying chin hair. So it's really like balancing the hormones. It isn't exactly like an absolute level you're aiming at, unless you might be more experienced in this than I am, but that's the way I do it in practice.
SPEAKER_02No, yeah, it's Taryn, actually, remember, we we talked to someone else about this, and I don't know that I necessarily knew this. I mean, look, men and women are different, different, but men, when we from my understanding, I I did TRT years ago, my levels were super low. I went on for six months, and then that was it. And I feel I feel great. I didn't uh you know, I just kind of got my levels up. But from my understanding is it's like men, okay, here's a blood test. You're, you know, here's your scale, 200 to 800. Uh, if you're at 200, it's pretty low. I'm gonna put you on, get you up to six, seven, eight hundred, you know, keep you there, and then you're good to go.
SPEAKER_03But, you know, Taryn, who is someone with- This is just this is just one of the areas where men are so much simpler than women.
SPEAKER_02That's that's it. Yeah.
unknownYeah.
SPEAKER_05Yeah, I would say that we it is much easier in men to replete testosterone because we have more guidance on on what the levels should be. But I'd say it's much more complicated in women because we have a menstrual cycle, people's baselines are different. Um I mean, I guess uh even if somebody had their ovaries removed and you were controlling for that, you still have adrenal glands. Like it's really hard to um know what someone's baseline should be.
SPEAKER_02One more question about this. I and Tara, I'm I'm sorry. I always say I'm sorry about monopolizing it, but like am I? I don't know.
SPEAKER_03But you're not, you're not. Yeah, I'm not really sorry you would change your behavior, but yeah, yeah. The absolute behavior change demonstrates that you're not that sorry.
SPEAKER_02Taryn is a is a is a neuropsychologist and also uh a former licensed uh family therapist as well. So she knows. Um now I just completely forgot my question. Um okay. Oh, so no, so the question is um Taryn, I Taryn, you and I talk about this. You you take control of your health, you are uh looking at things, you are having tests done, you're using devices to measure things, you're really actively taking agency over your own health. But a lot of women, uh, as Taryn, you and I have talked about, they'll just they just feel like, okay, it's just happening to me, therefore I'm just not gonna do anything about it. Doctor, like when should women start to maybe pay a little bit more attention and what sort of testing should they have done? You know, because you always hear in men, it starts to decline at 30. That's when we start looking at things. But when should really women take, you know, notice of this stuff and what what should they do?
SPEAKER_03I I I I love this, I love this question, maybe minus the should, because I think so many women get so many shoulds about what we should be doing with our lives. So I'd love to focus on like the could.
SPEAKER_02Like what are maybe you should have asked the question.
SPEAKER_03Yeah, no, it's okay. It's a great question. I love this question.
SPEAKER_05I love this question too, and this is why I do what I do. And I don't know if I explained this correctly, but I actually do primary care and general endocrinology. So I like combining the primary care health with hormone health, meaning that I don't think there's any life stage that we couldn't be paying attention to this. Am I going to say that everybody should? I can't tell anyone what to do. But I think women need to be tuned into how their bodies feel from the start of adulthood. It's not their job when they're kids to do that. So I'm just gonna say the start of adulthood and this idea that everything is stable, you know, from your teenage years until you're 45 is not true. There is, there are changes that are happening, you know, through your 30s, even. If you think we don't reach our peak bone mineral density or muscle mass, potentially until our late 20s or age 30. There's a reason we compare menopausal women's bone density to that of a 30-year-old woman. When we look at DEXA scans of menopausal women, that T-score we're looking at is comparing to a healthy 30-year-old female, because after that, bone density declines if you don't do anything. So although 30 seems very young, and in today's world, it is very young. Most people, I wouldn't say most, but many aren't even thinking about having children. I think that people need to be aware that their bodies and their hormones are changing even in their 30s, in their early 40s, and perimenopause isn't the first and only change. There are changes in hormone levels, neurotransmitters, neurohormones. And the best example I have from practice is when, you know, a 32-year-old says, I don't feel good, and we start going through the lifestyle and we talk about alcohol and sleep and stress, and they're like, but I've always done this. Like, I get that you've always done this, but maybe now your body's telling you something. You may not be in perimenopause or menopause, but your body at 32 is different than 25, and you may need to make changes. Not everything needs to be medicated necessarily, but maybe you do need to change how you manage your stress, how you balance your sleep, the way you exercise, the way you eat. And this isn't, you know, to punish anyone. It's to say, you know what, we have to be aware that our bodies are always changing. And I think that's what's unique for women, where it really isn't ever stable. Whereas for men, I think a slow decline may start in the 40s versus, you know, people talk about an abrupt decline for women, but lead up to that abrupt decline, there are still changes.
SPEAKER_02I'm not gonna say anything anymore because I'm gonna change my behavior.
SPEAKER_03Did you say you're not gonna say anything anymore?
SPEAKER_02I'm gonna change, I'm gonna change my behavior to show you that I'm that I understand.
SPEAKER_03I love it. Um you know, I think one of the fascinating things that I wanted to talk about with you, especially building on that last question, is you talked about how um one of the things that was really striking for you as a physician and and kind of ultimately led you to pursue this path of endocrinology and metabolic health is seeing women in particular be blamed for metabolic disease, for being overweight and obese. And in fact, the information or the guidance that they were given is just eat less and move more. How do we this sort of as a two-part question? How do we blame women less? Because we're women, we're we're already blaming ourselves for so many things. So, how do we blame ourselves less and what is the right information to have that's not just move more, eat less?
SPEAKER_05So, in these examples to understand how to remove the blame or the fault, is I would look at a scientific example. So we're talking about middle-aged women, perimenopause, menopause, where people are blamed when they say, I'm gaining weight, I can't sleep, and they say you're stressed, you need to eat less, move more. Let's look at women that get treated for breast cancer. These are women who may get chemotherapy, they might get their ovaries removed, or they get put on tamoxifen or anastrazole, which are anti-estrogen medications. Their metabolic health changes so rapidly. And this is a woman who has been put through either a surgical or a medical menopause. And things change so fast. You can't blame the woman there because she didn't do anything. It was such she, if anything, these women are extremely motivated to make changes to try to fight the effects of these anti-estrogen medicines or of getting their ovaries removed. And when you see that example, you know that it's not the woman's behavior, it's the effect of hormone change. So in these cases, I would cite like the most scientific example of abrupt surgical menopause or a medical menopause with anti-estrogen treatment that women get when they're treated for breast cancer. And if you look at that and you compare that to a regular perimenopause or menopause, there's I I can't imagine anyone that would look at that science and say, well, it's the woman's fault.
SPEAKER_03I love that. Um, I think this is my last question for you. Um, let's talk a little bit about glucose in our diet. Um, I have heard, this may just be conjecture, you tell me, um, that we're still like one of the few countries in the world that talks about dementia as opposed to calling it maybe something like type three diabetes, glucose in our brain. Uh, we still talk about glaucoma rather than talking about glucose in our eyes. I'd love to kind of bring this all together and have you tell us a little bit about, you know, is this glucose that's in our diet so detrimental relative to our health for things like dementia, for our eyesight? And can a GLP1 be helpful in maybe mitigating how much glucose we're getting into our system?
SPEAKER_05I love this question. And to be simple, I would say yes, excess glucose is toxic for all of our organs. It's toxic for our brain, it's toxic for our heart, for our liver, our muscles, our fat cells. So the question is, what is excess? Is it a straightforward amount? And that's where I'll say no. The more muscles you have, the more you can use up glucose. So if you're really active and you have a lot of active skeletal muscle, either genetically, from exercise, from weightlifting, then you can, it's hard to have excess glucose unless you're eating a ton of sugar. So it's a balance between what you're taking in and how much your muscles are using. So if somebody's very muscular, they have more wiggle room. They can eat more carbs, they can eat more sugar because their muscles act as a sink. The average American is quite sedentary, their muscle mass is low, and even eating a normal amount of carbohydrates becomes toxic because of low muscle mass. So, where do GLP ones fit in? Yes, they can modify all of this. They can help us with our carbohydrate metabolism, but even on a GLP1, you can get into trouble if you have no muscle. So it it's a it's a balance between the carbs and sugar you're eating, the muscle mass you have, and the GLP one you're taking. And that equation needs to be perfect. Not perfect, it needs to be manageable.
SPEAKER_03Amazing. That's so fascinating. I mean, we are talking about medical disorders like um the impact on memory and sight. And there is so little conversation about the impact that glucose has on us physiologically.
SPEAKER_05Yeah. I I joke and I tell my patients that I think the biggest hack is working your glute muscles. It's the biggest muscle in your body. When trained and active, the amount of sugar your glutes can use up is quite a lot. So, but everyone has like flat, untrained glutes. But if you actually had a strong butt, the amount of excess sugar you could use up is kind of a lot more than if you didn't.
SPEAKER_03Okay, wait. So let's so let's so let's operationalize that for just a second. So let's say as a woman, I train my glute muscles and I optimize them, and you'll tell us what optimize means. How much more glucose can my optimized glutes use as compared to the if I hadn't optimized my glutes?
SPEAKER_05That's a great question. And we probably can't even quantify it because the number of calories that the glutes burn at rest, if they're trained, can be like double or triple what fat fat cells would burn at rest. So trained glutes not only allow you act as a sink for sugar, but you can have a higher metabolism at rest. So not only could you potentially consume more calories and more carbs because the glute muscles would be active and act as a sink, but you probably can, you know, eat a pinch more. I mean, do I recommend only training your glutes? No, but I'm saying that like if you're gonna do nothing, like work on your ass.
SPEAKER_03There it is. I'm doing I'm doing squats today.
SPEAKER_02You know, Taryn, this this explains why I actually process glucose so well because of because of all the twerking, all the twerking that I do.
SPEAKER_03All the twerking.
SPEAKER_02Yeah.
SPEAKER_03Yeah.
SPEAKER_02Yeah.
unknownYeah.
SPEAKER_03This is a little known fact um about Mike, and I don't know that he's released this publicly before.
SPEAKER_02Oh boy, I'm I'm not sure I'm prepared, but go ahead. You can tell the world.
SPEAKER_03Yeah, but early, um, early in the days, uh, Mike grew up in uh the projects outside of uh Boston, and one of the things that he did early on was to work at Chuck E. Cheese. And this is like in the 1990s, and so they gave out awards, you know, for this. This is so great. This is so great. Chuck E. Cheese, um, like a paper plate award style, but I think it is an actual certificate. Mike still has it because he's very um so Mike received the award for best buns at Chuck E. Cheese.
SPEAKER_02Yeah, love it. Yeah, at an at a at a corporate entity that still exists. That was the award. And I will also say I received two awards. Uh, it was best buns and best looking as well. Um, so you know, and look where I am now.
SPEAKER_03You know, little did you know you were also protecting against glaucoma and dementia and processing glucose like a champ.
SPEAKER_02Yeah, because I was twerking in that kitchen like nobody's business.
SPEAKER_05Well, you both look very healthy. It sounds like your brains are healthy. I can't see either of your buns, but I'd imagine they're healthy.
SPEAKER_03Oh, well, thank you. Thank you for the vote of bun confidence. I appreciate it. Yes. It's like an Al Pacino quote from what scent of a woman? Is that what he's saying?
SPEAKER_02Yes, scent of a woman. Yeah, yeah, yeah. Yeah.
SPEAKER_03All right. Well, bringing us home, we are so delighted, Dr. Reiko Kumar, to have you here as the senior medical advisor of Found. And of course, for those of you that aren't yet familiar with Found, it is an incredible opportunity for you to check Found out. Um, Found has really grown, focusing on expanding choice, growing into one of the broadest metabolic medication formularies available today. I think there's something like more than 15 options if you're interested in checking out GLP1s and how you can expand and enhance your uh your metabolism, your metabolic health. And um, what we heard from you today is that the advent of the Wagovi pill is one of the most anticipated additions and really a strong signal in where weight care is going beyond injectable GLP1s for 2026. So it has been such a delight, uh, Dr. Kumar, to have you with us. Is there anything else that you want to share with us before we sign off or any other place where you'd like our listeners to come find you and check out your work?
SPEAKER_05Yeah, people can definitely find me on Instagram or LinkedIn. I'm Dr. Reka Kumar, easy to find. And I really appreciate having this conversation. It was really fun and informative for me too.
SPEAKER_03Amazing. Thank you so much. Thank you. All right, Mike, another great episode with Dr. Reka Kumar, who's the senior medical advisor at Found, um, and also a triple uh board certified uh endocrinologist in obesity uh medicine. She was so much fun and so knowledgeable.
SPEAKER_02She's great, yeah. Um, I just really love the guests that that you continue to find, uh just top of their game, you know, their education obviously speaks for itself, but they're also down to earth and you know, and personable and and really also excited about what they're doing and and how they're helping people, you know. Like I've had some, I think all of us have had, you know, maybe some bad experiences with some doctors that just lack bedside manners for lack of a better term. But these these guests that you're finding are just just just so great to to help educate not only me, but also our viewers and listeners, you know.
SPEAKER_03Yeah. I you know, uh thank you for that. And it's been a lot of fun to think about what guests would really um just be sort of a lighthouse of information. Um, because I think, you know, you and I started this this podcast because we wanted to be able to have these conversations and understand more about the array. This gets to one of your questions that you were asking about women. You know, what are the array of options for women and men that we have to optimize our health, to enhance our longevity for weight loss, for well-being. And um, you know, I think you and I wanted to have the conversations to be able to learn more about GLP1s, about stem cells, about uh evidence-based practice, about cold plunge, about sauna. And so um, this is a lot of fun because we get to learn right alongside all of you, our audience, um, and also get to ask a lot of the questions that we're seeing either come from you or come through on places like Reddit or from our clients and be just another resource for all of us to learn to really kind of democratize or share the information with everyone so that we all have an opportunity to enhance our health because um I think that's one of the greatest elements of wealth.
SPEAKER_02We end it there.
SPEAKER_03All right, everyone. Well, until next time, I am Dr. Taryn Marie Staiskel. This is Mike Alden, and this has been the Better Body Lab Podcast. See you next time.