GLP-1: The Metabolic Game Changer for Weight Loss and Fertility

In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols dives deep into the world of GLP-1 receptor agonists—medications that are making waves in weight loss and metabolic health. But could they also be a key to improving fertility, especially for those with PCOS and metabolic syndrome? Join us as we break down how GLP-1s work, their impact on insulin resistance, and why they might be the solution for stubborn weight gain. We’ll also explore the potential fertility benefits, their role in ovulation, and what the latest research says about their safety. Whether you're curious about GLP-1s for weight loss or fertility, this episode offers valuable insights. Don’t forget to share and leave a review!

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Transcript

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Today we talk about GLP one, glucon like peptide one, a key to weight loss, metabolic health and possibly fertility. I'm, doctor Mark Amos and this is taco. About fertility Tuesday, what if I told you there's a medication that can help with weight loss, improve your metabolic health and even support fertility for those with metabolic syndrome such as PCos? Well, today we're diving deep into GLP one receptor agonists and exploring how they work, who they benefit and what the latest research is saying. Now, I'll be honest, I'm not an expert in this area. However, I am an expert in things like metabolic syndrome. Matter of fact, most of my research was done on this and so im actually very familiar with the metabolic milieu. Its actually one of the reasons I love polycystic ovarian syndrome so much because it really is a picture of Met bulk syndrome in women. Now, I may not sound as fancy saying GLP one receptor agonists, but that is basically the medications you've heard, like ozempic, it is the same thing. Now, to understand GLP ones, you have to understand a little bit more about metabolism in general. See, when you eat food, what happens is the food in your stomach enters into the duodenum, which is the first portion of the small intestines. And there are special endocrine cells that sit in the duodenum that can then that sit in the duodenum. and then those send a signal to your pancreas through creation of GLP one because it knows that your glucose levels are going to start going up because of this food. Now, the GLP one goes to the pancreas and says, hey, I'm going to need you to make some insulin here soon. Now, it doesn't just make the insulin, but what it does is it makes it more active. So when the glucose levels then finally go up, then at that point, the GLP one receptors will make it more active and you'll make more insulin. The important part about that is that you don't want glucose levels high in the body all the time. There's a couple of reasons for that. One is diabetes. It's actually harmful for your blood vessels to have glucose levels high. But the other thing is that if the glucose levels are high all the time, your body will keep making insulin. Especially your body is not sensitive to insulin. It might even make more of it. And insulin is a growth hormone. It's anabolic, which means it will cause weight gain. The way it causes weight gain is it causes your body to want to absorb more of that glucose and store it as fat cells. And then this becomes a bit of a vicious circle, because the fat cells increase insulin resistance, which causes higher insulin levels, which then causes a vicious circle. And so many people who have metabolic syndrome, such as PCos, will know that there's eventually a weight. They get to where they really don't lose weight anymore, even if they did the same thing they did before they gained the weight. So let me give you an example. What I mean, let's say for five years, you eat 1500 calories. Then you know what? You meet someone, you have lots of fun, and for that next year, you eat 2000 calories, and now you've gained 25 pounds. And unfortunately, your body has now undergone a metabolic change. Now your body has this vicious cycle going on. And so you say, you know what? I need to lose some weight. I'm going to go back to my 1500 calories my first five years where I never gained a pound of. And something surprising is going to happen. You're not going to lose weight. Matter of fact, you may even keep gaining weight, maybe slower than before, but you're not going to lose weight. And the reason why is because of that vicious metabolic issue, the problem has already begun. You have these high insulin levels because of your insulin resistance, and your body is now making more insulin, which is having more of that anabolic effect. So the only way to fix it is by fixing the problem. And this is where GLP ones have, their magic. Because GlP ones help the body make insulin to the glucose levels. It's able now to reduce the glucose load and then eventually reduce the valve insulin that's being released by stabilizing the glucose levels, it's able to help then your body go back to the normal metabolic rate it was before, helping you lose weight, back when you're at that 1500 calories we talked about in that example. Now, glps also help weight in other ways. So other things they do is they help with gastric emptying by slowing it down. And the benefit of slowing down gastric emptying is when you have a large load of food that falls right into the small intestines, your body has huge blood sugar spikes, and that causes huge amounts of insulin to be released again, causing more storage of, the glucose as fat cells. So by slowing the gastric emptying, you are now lowering those spikes, lowering the amount of insulin that needs to be lead. But it's also doing another thing. It makes you feel full. We call that satiety. You don't feel like eating anymore because your stomach feels full, because it technically is a little bit fuller. But it even goes further than that. It also causes glucagon, which is another hormone released, but it suppresses it. And glucagon causes your glucose levels to go up. It actually causes glycogen to be broken down into glucose. So by suppressing that and not releasing glucose, and by increasing the amount of insulin for glucose levels going up, by getting the glucose levels down, it's able to stabilize your sugar levels, stabilize your insulin levels, and, as we talked about, suppress some of your appetite. But there goes another step. It actually goes further. It impacts the brain's hunger centers, which is in the hypothalamus, reducing cravings and overeating, which is one of the keys of sustaining weight loss. So this sounds like the most amazing drug on earth. It should help everyone, right? Wrong. See, it's not causing weight loss, it's helping people with this metabolic milieu be able to have weight loss. If you are someone who doesn't have insulin resistance, doesn't have glucose intolerance, then you're really not going to benefit from this much because it's not attacking your issue. So the point is, if you're eating 8000 calories a day, but you don't have a metabolic syndrome, this won't help you. You just have to stop eating a whole bunch. What this medication is great for is people who are actually trying and still not losing weight, because for them, it's unfair. They're playing by different rules. Everyone else gets to lower their calories and then they lose weight. But, for people who have metabolic syndrome, like people with PCOS, they can even lower their calories, and they still don't lose weight unless they lower them so significantly. That's very difficult, like 500 to 1000 calories a day for them to lose weight, because they have to break that metabolic issue. So the question comes, who's it good for? What's going to be good for people who have glucose intolerance, as I mentioned, insulin resistance, like type two diabetics and people who have central obesity. Central obesity is one of the signs of having insulin resistance. It's where that fat kind of sits around the belly, but not really in the arms or legs. Sometimes you even notice things like acanthosis, nigrans, which are on the back of the neck, there's a brown discoloration. Other signs are going to be having lots of skin tags on your neck. GLp one s are very effective for this. Now, if you give this to someone who is a type one diabetic, it won't help them at all, because for a type one diabetic, they don't even make insulin, so it can't help them make more of it. Now, sure, it might make them not eat as much because of the satiety issues. It might make them feel fuller, but it's not going to help in the major portion, which is the metabolic portion. So in the end, it is hormonal imbalances in people that allow GLP ones to be able to help them lose weight. Now, unfortunately, when it comes to medicine, there has been this gaffe where they tend to think that because you're overweight, that can be causing infertility. And although that can be true in certain situations, weight itself does not make you infertile. But if you have that central obesity, insulin resistance, or glucose intolerance, such as polycystic ovarian syndrome, then yes, you have a syndrome that happens to be exacerbated by weight and then that can cause infertility. So why am I bringing this up? Because glp one s can actually help you get pregnant because of the fact that you will fix that metabolic syndrome by making the insulin resistance lower, which is causing a barrier right now to fertility because you're not ovulating. There are many people which they call ozempic babies, where women have got on glp ones had significant weight loss, that weight loss causes insulin resistance to drop, and then that insulin resistance being down causes ovulation, which improves pregnancy outcomes. This is technically no different than the Met. Metformin. People have been using metformin for many years with people with poly six ovarian syndrome or with Met Bong syndrome to reduce insulin resistance. By reducing the insulin resistance, that then allows the body to start off healing again and help improve pregnancy. Even the environment of high insulin resistance causes inflammation and that even affects the quality of those eggs. So things like metformin and GLP ones, by lowering insulin resistance, even reduce inflammation in the body, lowering CRP levels as well as reducing inflammatory factors. But its important to understand theres a very big difference between metformin and glp ones. Metformin and GLP one have one thing in common. Neither of them are going to cause hypoglycemia because none of them cause insulin levels to go so high that it bottoms out the glucose. See, glp ones do increase insulin levels, but they only increase insulin levels in the environment of high glucose levels. So think of them as more of an enhancer when they're sitting on the receptors on the pancreas. It makes the pancreas react better to the glucose, causing the insulin to be released. The lower the glucose levels. But when they're sitting there and the glucose levels are low, they don't do much. They're kind of like a cheerleader. They're ready to cheer when it's time to, but the rest of the time they just sit back and say, well, wait, metformin doesn't cause insulin release at all, it just increases insulin sensitivity. So it works better. So you don't need as much of it to get the same response, but it does not actually cause release of it. Whereas other medications, such as giving insulin, if you give too much, you can die because you can get become hypoglycemic. There are other meds like glyburide, that can also cause insulin levels to be too high, causing the glucose levels to drop too much, but can also cause death. So what's nice about metformin and the GLP ones is that they are fairly safe to take because of the fact that they're not going to cause hypoglycemia. But just because they're safe and not causing hypoglycemia doesn't mean they're safe completely, which we'll get to in a minute. So let's assume you're listening to this podcast more from the standpoint of hey, I want to lose some weight and I heard these GLP ones such as Ozembic will help me lose weight. The answer is yes, it will help everyone lose weight in some way in shape and form. But some people will have more benefit than others. If you are someone who has central obesity or signs of insulin resistance, you will get the most benefit from this. Such as someone who is a type two, diabetic or pre diabetic. If you are someone who doesnt have any of these things, you will still get benefit because you'll have the satiety, not when they eat as much because of the delayed gastric emptying, your stomach's always going to fail full. Plus, we talked about how it goes to the hypothalamus and makes you feel full and not as hungry anymore. Now, in the world of fertility, using it for pcos at this current time would be off label. Now, if you're using it off label to lose weight with pcos, you're using it correctly. What I'm talking about is, could we use pcos to just help women with pcos reduce some of the symptoms of pcos, such as things like having high testosterone levels or having higher heart disease or other metabolic issues that come with metabolic syndrome. So the simple answer is yes. As you help insulin resistance, you also help androgen levels. And when androgen levels are high, it also causes insulin resistance, causing more insulin to be made. So by attacking one, you attack both. And that does lower the insulin environment, the androgen environment, and the inflammatory environment. So it helps reduce the risk of things like cardiovascular disease in people with PCos. And as you'd expect, it also helps with those things in people with met bog syndrome or with type two diabetes. What we can't say right now is that someone should take it trying to get pregnant, because there really is some controversies in this. Current research is looking at this in regular people and finding out will it help reduce cardiovascular risk in people who are non diabetic. There's also controversies that come up with is there harm? If you're taking it and getting pregnant, what harm does it have to the baby? Unfortunately, you can't design a study and say, hey, take this medicine. Let's see if it messes your baby up. In addition to that, its a very new drug. So we dont even have the time right now to know if its going to affect the babies because we dont have any babies that are ten years old who were conceived on Ozempic. And so currently we recommend that if youre going to be on Ozempic, that you would like to stop it at least a month, some even say two months before trying to get pregnant. I recommend at least six weeks. But right now theres some range because theres no actual study saying when to stop it. It's just expert opinion. One of the other things to keep in mind is it's very expensive, not everyone can afford it, and insurances won't always cover it unless it's specific for weight loss in a possible diabetic situation or metabolic situation. But sometimes they will deny it if you are non diabetic. The other thing is it does have side effects, nausea, vomiting. That's due to the delayed gastric emptying. So not everyone can tolerate it as well. So it's not always a great drug for everyone. The cool thing about the drug is it does have benefits, and it really seems to help a population that really doesn't have many tools to help them, such as PCos and metabolic syndrome. Usually patients in this situation are told to work out more, to eat less, and it's not that simple. Like the story I told you, when your metabolism changes, even doing the things that were before do not work anymore. And so these give them tools to be able to have success. Now, if we're going to look at this from a fertility standpoint, a couple things are important for you to know. Number one, if you are taking it, make sure you stop it at least six weeks before you're going to try to get pregnant. Now, if you're not trying to get pregnant, maybe you're just going through to retrieve eggs, or maybe you're just gonna make embryos right now, but not get pregnant because you want to stay on it, because you want to get your BMI down perfectly fine, but you still need to stop it two weeks prior to the retrieval or any procedure you're going to do. Now, there's some studies say it can be as little as a week. I would tell you, be safe. There's nothing more dangerous than regurgitating during a procedure and possibly going down your throat. So two weeks is what I recommend. Now, why does this happen? Because of that delayed, gastric emptying. Because the medicine is slowly letting the food into the small intestines again to prevent those spikes. Unfortunately, it's not leaving the stomach. So when the night before you're not eating, unfortunately, that food is still there. And then if you undergo your procedure and it hasn't been enough time, it's food is going to still be there. And if you regurgitate and that comes up, it can go down your lungs and cause severe problems or even death. Now, although GLP ones are a great resource for people in this situation with Medbox syndrome, there are other ways. One of the best ways to help is taking things that affect the metabolic milieu. That's going to be your metformin, myo nostal or GLP ones. But the other thing you can do is if you say, I want to keep this natural, you can just do extreme caloric restriction, meaning lowering your calories so much that basically you force the body into the right metabolism and you have to do that until the weight drops to a point where youre no longer in that metabolic milieu that creates this environment. And so thats going to be caloric restrictions around 500, no more than 1000 calories per day. Glps are very promising, and if you think about getting on them, talk to your healthcare provider, especially if you have med bulk syndrome, PCOS, or other conditions such as diabetes type two, where it may benefit you. I don't know if you're going to maybe want to use glp ones. Maybe you have a friend who might use them. or maybe you just want to know about them because all the famous celebrities are on it now. Hopefully this episode was helpful for you and you were able to learn a little bit about this new emerging drug that seems to be everywhere. Now. I want to point out one more time, I am not an expert, but I am an expert in metabolic syndrome. And this drug is really a magic bullet for people with metabolic syndrome. If you like this episode, please tell a friend about it. Tell others about maybe someone who just wants to learn about glp ones and doesn't even care about fertility. And most of all, if you like, us, give us a five hour star review on your favorite medium. As always, keep coming back. I'll see you next week on taco Bell fertility Tuesday.