The Dr. Hyman Show - What We Got Wrong About GLP-1s (And What's Right) | Dr. Tyna Moore

Episode Date: August 12, 2026

GLP-1 medications have changed how we treat obesity and metabolic disease. But as their use has exploded, so have questions about side effects, muscle loss, long-term use, and whether patients are receiving the support they need to use them safely. In this episode, I reconnect with metabolic health and regenerative medicine expert Dr. Tyna Moore to revisit our conversation from two years ago and examine what we’ve learned since. We discuss: How to tell when your GLP-1 dose may be too high What you can do to protect your muscle and bone during weight loss Which metabolic and nutritional markers should you check before and during treatment Why weight can sometimes return after stopping a GLP-1 What emerging research suggests about GLP-1s beyond weight loss GLP-1s can be life-changing, but a lower number on the scale isn’t the same as better health. Ultimately, how these medications are used—from dosing and monitoring to nutrition and strength training—matters just as much as whether they’re used at all. Additional resources: Join Dr. Tyna Moore’s community Listen to Dr. Tyna Moore’s previous appearance on The Dr. Hyman Show View Show Notes From This Episode Sign up for Dr. Hyman’s Brainshaping Academy to learn how to nourish the biological systems that support your mental, emotional, and cognitive health https://drhyman.com/products/brainshaping?utm_source=dr_hyman_show&utm_medium=newsletter&utm_campaign=may_27&utm_content=link Get Free Weekly Health Tips from Dr. Hymanhttps://drhyman.com/pages/picks?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Sign Up for Dr. Hyman’s Weekly Longevity Journalhttps://drhyman.com/pages/longevity?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Join the 10-Day Detox to Reset Your Healthhttps://drhyman.com/pages/10-day-detox Join the Hyman Hive for Expert Support and Real Resultshttps://drhyman.com/pages/hyman-hive This episode is brought to you by Seatopia, Perfect Amino, Cozy Earth, Timeline, Sunlighten, and Made In. Find a cleaner source of seafood. Check out seatopia.fish and use code HYMAN for free shipping on your first order. Get daily protein support at bodyhealth.com and use code HYMAN20 for 20% off. Head over to cozyearth.com to save 20% and upgrade all of your daily essentials today. Support healthy aging and get 20% at timeline.com/drhyman with code HYMAN. Discover why so many people are using sunlighten.com and use code HYMAN to save up to $2,100 today with free shipping. Upgrade your cookware at madeincookware.com and save 10% off your first order with code HYMAN-HIVE. (0:00) Introduction, Dr. Hyman's evolving views, and episode goals (0:43) Sponsor: Rose Nutrition Liposomal NAD (1:42) Sponsor: Seatopia clean seafood box (2:44) Disclaimers and Lyme disease preview (4:04) Guest Dr. Tina Moore reintroduced (4:30) GLP-1s: Effects after years and microdosing strategies (7:14) Risks of high-dose GLP-1s and misconceptions about muscle/bone loss (13:09) Functional deficiencies and microdosing approaches (17:05) Sponsor: Made In stainless clad cookware (18:02) Sponsor: Timeline with Mitopure (18:58) Broader and additional benefits of metabolic health and GLP-1s (21:48) GLP-1s for immune and brain health; genetic differences (27:59) Introduction to peptides and GLP-1 drugs (32:36) Gray market concerns and weight regain after stopping GLP-1s (37:14) Long-term safety, cost, and personalizing GLP-1 treatment (40:57) Emotional blunting and recent concerns about GLP-1s (46:30) Functional medicine approach: addressing root causes (46:46) Sponsor: Sunlighten Sauna (47:20) Sponsor: Magnesium Breakthrough from Bio Optimizers (48:17) Dr. Hyman’s evolving perspective on GLP-1s (49:19) Hormonal effects of GLP-1s for men and women (55:02) Baseline lab markers and tests before GLP-1s (57:10) New and next-gen GLP-1 therapies (59:43) Telemedicine, gray market issues, and importance of reputable practitioners (1:05:57) Rapid fire: Alcohol, common mistakes, misconceptions, and eligibility for GLP-1s (1:08:16) Key lab tests and surprising non-weight benefits

I've changed my opinion over the years on this. At first I was skeptical and I changed my position. And I think the one thing that this whole journey has showed all of us is that metabolic health is the core of everything. These peptides improve metabolic health overall. And when we see metabolic health improve, we see all kinds of benefits across the board. Regardless of weight loss, like irrespective of weight loss, we're seeing really great benefits happen.

And yes, there's direct mechanisms of GLP ones. They land on immune cells. They land on receptors around the body. They have a direct impact that we don't even fully understand. Yeah, I think that's a really important framework for people understand JLP ones because a lot of doctors just prescribe them. These are, I think, a real benefit to humanity. The question is how do we use them right?

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worth of supplements. And honestly, it does taste so much better than a pill. Get your first box at Cetopia. Dotfish and use the code Hyman for free shipping. Before we begin, I'd like to note that today's conversation explores one perspective, of an area of medicine that continues to be actively debated. And while we discussed emerging evidence and critiques of current psychiatric practice,

treatment decisions, especially involving antidepressants or other prescription medications, should always be made in consultation with your health care provider. The views expressed by my guest are her own and reflect her interpretation of the available evidence. My goal in hosting conversations like this is to explore different perspectives, to examine the science, to encourage thoughtful discussion,

not to provide individualized medical advice. So if you're currently taking medication, please don't stop or change your treatment based on this conversation alone. Instead, use this episode as a starting point for an informed conversation with your health care team. My hope is that these discussions encourage curiosity, critical thinking, and shared decision-making between patients and their clinicians. So before we wrap up, if you found today's conversation on Lyme disease helpful, be sure to check out my upcoming conversation with one of the world's leading Lyme experts, Dr. Richard Horowitz. We go beyond Lyme disease itself to explore why so many people remain chronically ill.

We explore his groundbreaking emson's framework for understanding chronic disease. And we also look at the biggest drivers of chronic inflammation and what it really takes to help the body heal. So be sure to check it out on this Wednesday. Here's a preview. If you enjoyed today's episode, don't miss my upcoming conversation with Lyme disease expert Dr. Richard Horowitz. We dive into why so many people stay sick. And we look at the hidden drivers of chronic illness and a whole new way of thinking about inflammation and recovery and healing. It drops this Wednesday, and until then, here's a preview of what's to come.

All right, Tina, great to have you back on the podcast. Good to see you again. How you doing? Thank you. I'm so excited to be here. It's nice to see you again, too. All right. Well, last time we talked, we kind of dove into a lot of the controversies about JLP1. We talked about the benefits, the side effects, about microdosing, the way that costs, many, many things that were sort of up in news and in practice at that moment. But we've been kind of down the road for a few years now. with GLP1s. They've been on the marketplace. People are using them. There's millions of many people on

them. We want to kind of know the good, the bad, and the ugly around this. And what, what benefits potentially there are beyond weight loss? What are we actually seeing two years later? So you were on this show in April 24, and it was a huge conversation we had around that. And I think the question is like, what's changed since then? One of the biggest takeaways from our conversation was the sort of idea of the dose, the dose that it's in prescription, GOP1 drugs like Hosemp or Rogovi or Zep bound or much are high doses and they cost significant side effects. And, you know, when you look at the data, I mean, a lot of people, 60, 70 percent of people

have some GI side effects, 4 percent of very serious side effects. If you're talking about, you know, 40, 50 million people taking them, the number gets pretty high. Four percent of 40, 50 million is a lot of people. So what's kind of evolving you're thinking over the last couple of years, sort of let's kind of dive into that and some of the research findings that are sort of, you know, new and emerging that kind of we should we should touch on that that episode like blew the top off it felt like and suddenly everybody was sort of bum rushing in asking me questions and my life

got crazy after that it was it was exciting in a good way I think what I was trying to lay down in that conversation I didn't fully get to explain and it was kind of a functional medicine approach overall really you know and so I think that that's where a lot of the confusion lie for people was they didn't quite understand this comprehensive approach. I would say two years later, I am more firmly planted in my stance that keeping the dose as low as possible is the necessary step and that for whatever the needle we want to move, whatever that may be, and that might be getting into regular dosing, it might be getting on the spectrum of regular dosing and that's all fine and good, but really where I land at this point, it's more strongly than ever is to your point

that I know we both agree on that lifestyle is first, doing all the things, making sure that this is just part of a comprehensive treatment plan. It's not the whole thing. It's not monotherapy. That's really what I was trying to lay down from the beginning. And that got lost in translation because you know how people are. They hear what they want to hear. And they're like, oh, microdosing, it's a miracle. It's going to work for me. But they're not doing anything else, right? And so that I think all these years later, that's where I'm even more, you know, I'm like, okay, guys, you still didn't listen. We have to do all the things.

And this is just a tool in a toolbox. Yeah, I think that's a really important framework for people understand JLP ones because a lot of doctors just prescribe them. There's all these prescription meals out there online. You just kind of have a telehealth visit. You get the prescription. You get the drug and you're on your own. And that, I think, is mouth practice.

I think if you don't prescribe these drugs in conjunction with proper nutrition training, education, and strength training, it's really kind of productive for the person who's taking the drug because it ends up causing more problems down the road. They tend to lose more muscle, lean body mass. They tend to end up, you know, gaining the weight back if they stop, which a lot of people do, with the high doses, and then they end up in this vicious cycle where their metabolism is slower. They need, you know, less calories at the same way that they were. And it's just a vicious cycle.

So in terms of the fundamentals around lifestyle, I think we just sort of touch on this before we go into some of the newer issues. I think people need to understand that, you know, what these drugs do at the prescribed doses. And then I want to sort of have you maybe talk about how they work at the smaller micro doses that you've been recommending in terms of the impact on the importance of sort of lifestyle change, diet, exercise, string, training, protein. They are endogenously created in our bodies. in our gut, in our L cells, and in our brain, and we have receptors all over our body. At the standard pharmaceutical doses, I think that those doses are really high for most people,

and they are designed to decrease gastric emptying, slow down gastric motility, and then also they play in the brain by impacting satiation and satiety and your hunger signaling and how you feel about that. So ultimately people eat less, lose weight. I do think there is a, and this can be argued by some, but I've looked at the data and I think there is some overall metabolic impact that is outside of weight loss, that harmonizing

of the signaling peptide hormones across the board, that depending on the person and the individual they're being used in, at the dose they're being used at, and I think that ultimately does improve insulin resistance, which ultimately improves weight loss. It's not just eat less, you know, they're not just starving themselves down. So it's multifactoral. That said, at high doses, you really can start cranking on the gastric motility and it will shut things down. That's not great. I do think the real risk of pancreatitis is real.

The gallstone issue and the pancreatitis due to a gallstone being thrown into the pancreas is real. I've seen it personally in my practice. I've seen a bunch of people with increased pancreatic enzymes like amylase and lipase. And it's surprising, you know, and I think we're, I mean, given how few people, people I have taking them that are my practice, I'm surprised to see how many people I've actually seen with pancreatic enzyme elevations. I think we have to look at this, though, without getting two in the weeds and pull me back if I go on a rant. But I think we're looking at two different cohorts of people here. Three, really. We've got the type of patient who

these were designed for, which is your generally quite obese, type two diabetic person suffering with those conditions. And they are coming in with. such a compromised system already, right? And then they're getting thrown really high doses. And I don't think that's a great recipe for success. And I agree with you. I think it's malpractice and completely unethical to just monotherapy these people and not give them all the tools that they need. But let's face it, most doctors don't strength train themselves. Most doctors are not, I mean, the amount of doctors with fatty liver. I did this morning. I went this morning. Good for you. Me too. I knew. I knew you were going to, I was like, he's on it. You don't

stay looking good at your age without strength training. Like that's just we don't, we're not going to, When people are like, what's your secret? I'm like the gym. That's about this extent of it. Grunting in the gym. You know, good living and yeah. The middle cohort, which I think since our conversation has really benefited from these peptides and from doctors who do bring a comprehensive integrative approach is kind of that middle

group where they've maybe got 30, 40, 50 pounds to lose. The weight, the excess weight on their body is definitely causing some metabolic dysfunction for them. Maybe they're postpartum. They've had a few kids. Maybe their metabolic health got derailed along the way. Whatever it is, they're benefiting. They're doing it right.

They're doing all the things. It's a really good harmony. And those folks, to get that weight, the needle to move on the weight, I really do think you need more standardized dosing or close to it. And then there's the cohort I was trying to have a conversation about, which I realized I think I was just too, you know, when you bring ideas, it's too soon for their time. You know, the world was not ready. to hear what I was trying to lay down and I really had to explain functional medicine in order for this concept to work. But I was trying to introduce this concept of microdosing, which was really microscopic,

I mean, micro, like these people clearly have never done drugs because they don't know what a microdose is. And I was trying to suggest a fraction of the starting dose in those who were already metabolically optimized, who were already doing all the things, because as you know, we have struggles too. We have autoimmune disease too. We have histamine issues too. We have all kinds of issues too.

We might even get metabolic compromise. I've seen very lean people with good muscle mass end up with terrible cardiovascular markers and terrible metabolic markers. And so for whatever reason, stress, genetics, epigenetics, who knows? So that was really what I was trying to go after was like, hey, maybe we could utilize them too and we could consider different dosing strategies and almost a different approach between these three groups. And I was thinking, honestly, more of like a lotos naltrexone was kind of where I was coming

from with it. This idea that if the body is deficient for whatever reason, and I do think there's functional deficiencies of GOP ones. We have a study from, I think, last year showing that statin drugs decreased endogenous GOP run production by 50%. Well, that's interesting. That may have explained why it increases insulin resistance because when you look at statins, they increase insulin resistance and increase the risk of diabetes significant.

So that may be the mechanism interesting. Right. So I was just thinking across the board, you know how we are in functional medicine. If somebody is physiologically deficient in a hormone, we supplement that hormone. We're not giving them super high doses. We're giving it back. It's physiological doses. Yes.

It's not pharmacologic. It's just a little bit, a little bit of something, something. And so that's where I was coming from with it. That idea was really difficult for people to understand, I think, or just to, you know, comprehend what I was trying to lay down. And if you look at low-dose naltrexone, the, way that I'd explain it to patients is if your opioid, I mean, not to get in the weeds, but just so people understand, that's an opioid receptor issue, opioid-like receptor.

And that modulates your immune system. And if your system isn't working great, we give you a tiny little bit of naltrexone at a very low dose, and it helps your body use what it has work better. And that was kind of my thinking with a microdosing strategy, was just give the body a little bit back what it needs and maybe the system itself will work better because we know that left an agrelin and all of those signaling peptide hormones orchestrate with glp1. They all work together that we need the gLP one on board. And so anyway, it was kind of like three different concepts that I was trying to get out in one

podcast. So I think where we are now is that a lot of people have opened up their minds to the fact that maybe gLP1 has a place, whereas I think before they were viewed. vehemently against it. There was a lot of, you know, clickbait online and scaring people. I do want to say just before we lose anyone in the audience as we go on in this episode, the muscle mass thing, we have to talk about that because the earlier studies, that JAMA study that we referenced in that last podcast, that was showing up to 40% lean mass loss, right? Lean mass loss and everyone, oh, it's 40% muscle. That is incorrect. Lean mass. And what I was hypothesizing back then,

And I was like, well, what about the fatty infiltrate and the liver and the muscles that folks do very characteristically get when they get metabolically compromised, right? And now we know that lean mass on Dexha is everything that's soft tissue besides bone and fat. And so when we're looking at lean mass, we're looking at interstitial fluid. We're looking at we're looking at tendons and ligaments and muscles. Your muscle mass only makes up maybe at most 25 to 40 percent of that overall lean. mass number. So that number got over sensationalized and everybody got really scared. The studies have come out and shown pretty decently. We've got some mouse data. We've got some human data. It's not

chewing up muscle mass. It is right in line with any low calorie, caloric restriction diet. It's right in line with bariatric surgery. There is no excessive muscle loss happening. The GLP1 as a mechanism is not destroying muscle. In fact, it's probably protective in a lot of ways. a muscle? Interesting. And a bone. The bone loss we're seeing really is when people, when you lose weight, you lose mass. And when you lose mass, you lose gravity. And when you lose gravity, you lose that downward pressure on the bone, right? So we see people maybe waste too quickly, lose weight too fast. They're not putting any other tension or pressure on that bone. And so they do start to lose bone. But it's not a mechanism that's direct from the GLP.1. So that I just wanted to say out loud

because we have to put that away. So what you're basically saying is that the muscle loss and lean body mass loss is the same as you see with regular weight loss if you don't strengthen and eat enough protein. If you don't protect your muscle along the journey, it's exactly the same. And it's not excessive. The GLP ones are not coming from your muscle. There's not a separate mechanism where they destroy muscle by any means. So it's just the fact that you lose weight loss without exercising is the thing and eating

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healthy aging from the inside out. Visit Timeline.com and use the code Hyman for for 20% off your order. And I think the one thing that this whole journey has showed all of us to, for the defense of you and I that have been beating this drum for God knows how long is that metabolic health is the core of everything. And these peptides improve metabolic health overall. And when we see metabolic health improve, we see all kinds of benefits across the board, regardless of weight loss.

Like, irrespective of weight loss, we're seeing really great benefits happen. And yes, there's direct mechanisms of GLP ones. They land on immune cells. They land on receptors around the body. They have a direct impact that we don't even fully understand. But all in all, when you improve metabolic health, a whole lot of conditions that we just thought people had to live with suddenly go away. And the world at large is acting so shocked. And I'm just over there like, yes, this just confirms the, you know, my life's work.

Well, I think, Tina, this is a really important message. Just double click on here for a minute. I have a hypothesis, which I'd love your perspective on, which is if you improve metabolic health by any means, you'll get the same results. In other words, I don't know how much extra magic there is in JLP1s other than helping people get in better metabolic health with a little bit of an assist. And if you were to put people on food is medicine, lifestyle intervention, with the proper exercise and nutrient replication, that you would see.

pretty much the same benefits as GLP ones. And I don't know if that's true. That's my hypothesis. The reason I say that I saw a study once on bariatric surgery where they did a randomized control trial. Essentially, they, or it was maybe, I don't know what the design was exactly, because I don't actually operate on the second group. But it was basically a group that had bariatric surgery, you know, with diabetes,

and then another group that had the same dietary intervention as if you'd already had the surgery. In other words, they gave them the same food that the bariatric surgery patients had to eat, essentially. And there was absolutely no difference to any of the weight loss, metabolic markers, anything else. So it was purely the food. And it was sort of like to paraphrase Bill Clinton, it's the food stupid. So I don't know how much extra advantage there is to JLP ones. It's certainly, it's sort of an assist, I would say.

It's a support for people who struggle. It can help break a cycle of addiction, break a cycle of various things that happen metabolically that are hard to break. But is there something special and unique about these that are over and above just the weight loss that you see? Because you're right. If you improve metabolic health, you improve cardiovascular risk, dementia risk, hormonal health, you know, immune health, inflammation levels, obviously your risk of, you know, diabetes,

all these things get better. Mood gets better. Brain health gets better. You know, psychiatric conditions get better. And it's not like some magic kind of thing. So I'm just wondering your perspective on that. I think they do. And I'll give you a couple examples.

Well, for one, we know they land on immune cells. There's receptors on our immune cells, and they land on mass cells in particular. So they can help significant improvements in folks with mass cell activation syndrome. And for those who are listening, that is essentially a syndrome where you get like very allergic to everything and you have high histamine levels. Yes, and it's miserable. These folks can't take anything. And I've got colleagues using one one hundredth or one-fifference. of the starting dose, tiny, tiny little doses of terseptide.

And suddenly the patient's inflammation will regulate out so then they can actually get to work and start utilizing different therapeutics and modalities, whereas before that would flare the patient. These patients were very sensitive. SERS patients, Lyme patients. I'm watching doctors utilize these at very small doses just to kind of stabilize the immune system. Tons of reports from people, I've gotten thousands and thousands of messages over the past

for years of people saying, I was able to go off my antidepressants within a few weeks. I stopped gambling. A study just came out like I just saw it this morning when I was getting ready. This is crazy, Mark. They compared folks who were alcoholics and other drugs utilizing who had been on GLP ones and they found that whilst on the GLP one, and we know this because there's some data coming out now around alcohol, cessation, smoking. And we talked about that a little bit last time, they not only had significant improvement when they were on the GLP one, but the results lasted up to like 30 or, yeah, 30 or 40 percent. I think it was like 39 percent improvement even after discontinuation of the GLP one. So there's, it's changing the architecture in our brain

somehow. It's, it's playing on the dopamine pathways. And I don't know, depending on the dose, I don't know how good or bad that is, right? I mean, we can, that's a whole other dilemma. But I do think there's several different mechanisms happening. I've seen, this is another crazy one. I just have to throw out there. A lot of people have come into my DMs. I'm in a really unique position because I have a lot of followers that message me about this. And I mean, hundreds of thousands of followers across platforms.

And a lot of people are having their disordered eating disappear. These are bulimics and anorexics and orthorexics. And at a microdose or at whatever their dose is, it completely obliterates. the actual under-eating. It's not making them under-eat. And then cancer, I've had a few people who are using it with cancer. Doctors, oncologists are now using it with patients in conjunction with their cancer therapy and approving it, which I thought was nuts and exciting. These folks are having better outcomes across the board. Their quality of life is better. Their mood is better. And they, it's not completely crushed. In some cases, it might be depending on the dose, but it's not

completely crushing their appetite. In fact, it's helping them eat. So I think it, I think it does something in the brain and plays both sides of that. I don't know how, but. So it seems to have, it had unique brain benefits around addiction, around, obviously, apta regulation, but also immune benefits. Immune benefits. So these immune benefits are fascinating to me. Do we, do we understand the mechanism yet of how these work on the immune level? Because we know inflammation generally goes down as your mental health gets better, right? Your medical health the term is the little because your visceral fat is all inflammatory. So is it just that or is there something else going? I don't know. I don't know. I just know that they land on mass cells. I was trying

to get every single person I knew who had MCAS to try a microdose. I was like, please just tell me what happens. Just take the microdose and tell me what happens. And everyone who did miraculous, the responses I got from people were like, I can't believe I waited. This has changed everything for me. And they can tolerate the world now. They can go through the world and live like normal people. They're still watching what they eat, but they can have a glass of wine and not have their whole life derail. You know, like they can function. They can eat fermented foods again. They can, which is, here's the important part is they can eat fermented foods again.

And they can eat so many of these high histamine foods that these folks have to avoid usually are the same foods that bring us optimal health. And these are on the micro doses, right? Yeah, the or depends maybe on a regular dose. And that's the other part. A study came out last year showing genetic differences in people. So some people have very different responses to GLP ones depending on their genetics. Some don't respond at all. That's why there's non-responders.

Some get more nausea than others. And so that kind of proves what I was getting at in 2024 is like, I think we're all really different. And I think we have to really look at different dosing because some folks are not responding to some of glutide and terseptide helps them. It changes their life like night and day. The difference is some people don't respond at all. It's kind of all over the board.

And so I think dosing is very individualized still. What might be low for one person might be a regular dose for someone else. It kind of depends. And it does depend on how they're eating and it does depend on their overall metabolic health. I will give you that. And it does depend on how much they're hitting the gym. But that said, I still think this is a tool that is in conjunction with and not instead of. You got to do everything you said.

You have to do all the lifestyle pieces too. Yeah. And that part, I will say, people I've noticed with my patients. You want to skip that bit. Well, you know, they start out strong. They start out with good intentions. But the minute that GLP1 kicks in, and it's, I call it kind of the ultimate F-around and find out peptide because it does clear up so much of the inflammatory noise for some people

that they're like, I can eat gluten again, I can handle carbs again, I can do all these things again. And eventually there's a concept in medicine, you know this, but for the audience, it's called Tachyphylaxis, and it's where you acclimat to drugs. Yeah. Yeah, you acclimat. very quickly to the drug, and this is known for that. And so all of a sudden, they find out. It comes back to haunt them. So it's not a get out of jail free card, and you still have to do all

the lifestyle pieces. And eventually that microdose will stop working if you keep effing around and find out. But I think that as a tool for those folks who are doing the things, or maybe those folks are not doing the things, and this is the thing keeping them alive. I don't know. It's a lot of different applications. Maybe we can back up a little bit because we kind of jumped to head out. I think maybe for people listening who don't know exactly what peptides are or exactly how these new drugs, these gelp-p-win drugs work, help us understand it because most people don't realize that these are things that our bodies normally make, but we're either low in them for different reasons, like you said, like statin use or maybe there's other reasons. And how do they

actually, how do they do their job? So GLP-1 is a peptide that our body makes. It was first discovered, or a version of it was first discovered in Heela. Well, I shouldn't say that. I looked up the history. It was discovered in humans, but then it was rediscovered in Heel lizard venom. I live in the high Sonoran desert, so we have Heel monsters out here. I've seen them. They're pink.

They're very pretty. But what they found was the Heel monster only has to eat a couple times a year. And so they isolated this Exenden 4 out of its venom and said, hey, this is the thing that keeps it from needing to eat. And that is not what GLP ones are. They then looked at humans and said, oh, humans have a similar mechanism. And so for everyone's saying, have you heard that, Mark, that going around, that it's derived from, OZempic is derived from Blizzard Venom. I haven't heard that now. You're blissfully unaware of the nonsense on the internet.

I started just blocking people who send me those videos. I'm like, I can't. I can't even get into time. Yeah, I try not to pay attention to the noise and just stay on the signal. Stay on the mission. Stay on mission. We make it in our guts and we make it in our brains and it goes throughout the body and does different things.

And it is definitely from what we understand. I think we're just beginning to understand all of these left and grow. And I think we have a really rudimentary understanding of them. But it is in that family. And like I said, it plays on the gut. It plays on the brain. It plays on appetite. It plays on your insulin.

And it helps your insulin signaling improve. It helps it signal when it's supposed to signal more appropriately. The drug itself. is it's just a peptide. A peptide is a string of amino acids. Strings of peptides are proteins at, you know, at like fifth grade level biology. And so it's a very simple system. And then the pharmaceutical companies have tweaked the molecule, or they, I'm sorry, the string of amino acids, the peptide, to have a longer half-life. Because our naturally occurring, GLP1 is in and out of our system very quickly. And then this one is in and out of our system in five to seven days.

So they tweaked it a little bit. It's not exactly biore identical. It's a little tweet. It's pretty close, but yeah, I think it's like 93 or 94% bioidentical. Semaglutide. That's just pure GLP1, semaglutide. That would be OZempic and Wagovi. I'm sorry, OZMPIC and Waygovi. Same medication, same pharmaceutical company. One's FDA approved for weight loss.

One's FDA approved for type 2 diabetes. And then we have terseptide, which is a dual agonist. That's GLP1 with GIP. GIP has different mechanisms inside of our body that help regulate our blood sugar and supposedly the GIP should be helping sequester and get fat oxidation going better. And that would be Tersepaite, and that is Monjaro and Zepbound. Again, same company, same molecule, just two different FDA approvals. And then we have the new kid on the block, which is read a Trutide.

Oh, let me back up. Tersepatide is like, I think one to five. I might be off a little bit from what I've researched. It's a one to five ratio of GLP1 to GIP. So when people say, oh, look at all these benefits and the studies of GLP1 in particular, not the medication terseptide, but when they just studied GLP1 over the past many decades, there's less GLP1 in terseptite overall than there is to GIP. The ratio is different.

And then with retitutide, that's a triple agonist, and it has glucagon agonism, which they thought might help preserve muscle mass. I don't think that's coming out to show, but in the studies, but it has, that, that medication has tremendous weight loss happening with it and a lot of fatty liver, a lot of impact on the fatty liver, which is really cool, but that has very, very little GLP1 in it overall. It's mainly, mainly GIP and glucagon. But that's not really available yet, right? No, that is in phase three trials.

I just saw this morning that they're hoping for, I think, 2027, and they're trying to get it classified as a biologic and not what it would normally be. So then it can't be compounded. And they can really throw the hammer down. And they can really jack the price up. But I've seen people selling it on the gray market. Yeah, the gray market is like the Wild West. So you can get it, but you don't know what you're getting, you know, if it's safely produced, if it's the effective dose, if it's got some of the contaminants in it. you don't have any idea.

I think that's another conversation we'll have in a minute. But, you know, these things are really quite interesting. I think that, you know, I kind of want to just step back a bit because I think people have heard about a lot of side effects. And I did a bunch of research recently about this. And I think your weight loss, muscle loss concept, it makes sense to me. And I actually have had that thought that actually, you know, the weight loss is the thing without exercise that drives.

the muscle loss if you don't do strength training and you don't do protein. The other thing is the weight regain because when people stop it, there's a lot of data from the step one trial and others that people who lost a lot of weight within when you're stopping, they regain two-thirds of the weight. And also all the cardiometabolic improvements reverted toward the baseline. Same thing happened with the surmount four trial with terseptide. So, you know, they're good while you take them. But then is there's a sort of ozempic rebound phenomena that happens? And what do you make of that?

Yeah, I completely agree. And to your defense in that study that came out last year in November of 2025, they looked at two separate groups. They looked at the GLP1 group and then they looked at lifestyle group. And the lifestyle group was not taking a GLP1. And when the weight regain happened for all of them, I think keeping weight off, I said this on your last episode that I was on, and people came at me and got really mad.

the weight loss part is actually the easier part. It's the keeping the weight off that is so significantly harder. And I think what, like 5, 10% of people who go through a weight loss journey will actually keep it off. It just keeps coming back. The fat cells have memory. And the body has a set weight. And it all wants to come back. And like you said, when you get lighter, so you lose the fat, you lose the leptin. The leptin and the grelin are playing with your appetite. And it is very, very difficult to keep the weight off. And you're set points. point stays where it wants to stay depending on how long you've been at that weight. So the gLP1 group, the terseptitide and semaglutide actually had faster weight rebound. The newer

in Creighton medications had faster weight rebound than even some of the older ones, which tells me the fancier the peptide, the fancier the medication, the faster the weight regained. The faster you lose it, the faster weight regain. But I think that's, we know that with weight loss anyway, right? That was before there were GLP ones. We knew that. And so going on a slow and low journey, doing it right, utilizing this opportunity as a window of opportunity to completely modify lifestyle and do all the things, I think is obviously the best route. And then knowing that you probably should be, and I think doctors are getting hip to this, there has to be a titration strategy. And we might be looking at some people as lifers. There's going to be a subset of people that are

on this for the rest of their life for sure. And there's other people that may be able to come off. And I think we don't have enough studies. They're looking finally at studies of GLP1 and strength training. We don't have any good studies on that yet. But when you, there is a study out from a few years back, same group that's doing the current studies. Utilizing strength training during a weight loss journey leads to appreciable weight loss retention. Yeah, it's quite amazing. I have a number of patients like that. I've had, they've really struggled with weight. I got them on low dose guilty ones. And then I said, look, you have to be in the gym. You have to do Dexas scans every month. You have to like eat this protein. And they do it. And they're doing it. And it's

quite amazing to see the muscle, the weight will go down, but they'll actually increase their muscle and they'll lose even more fat. And so you lose, you know, 10 pounds of fat and you gain five pounds of muscle, your weight loss is only five pounds, but you've changed your body composition. So it's quite interesting to see that that's possible even with these these compounds. Yeah, that's really the question that I'm sort of noodling with. Are these lifelong drugs? Are they safe long term? The cost, I think, is coming down, which is good, but it's still a lot. And I don't think insurance still pays for most of it, except you're diabetic. And so it's really, you know, we're kind of in this gray zone of

not really knowing what happens if people take these for 10, 15, 20 years, right? And do people need to take them if they want to sustain the metabolic, benefits and not kind of rebound like most people do. Before GLP-1s came on the scene, I was really concerned about the just overall metabolic health of our nation in general and how we were exporting it out to the world. And I mean, like, I used to, I'm sure you have too. Like, it used to really keep me up at night. I was like, this is a disaster.

We are a metabolic disaster as a society. That's why I've written like 20 books on the topic. I know. I know. We are. And then, right. And then COVID hit. And I was like, oh, this is going to be a hot mess because that, you know, it preferentially

impacted folks with metabolic compromise the most. And I think that we're in a pickle. And we have skyrocketing rates of infertility because of all of it. And nobody wants to talk about that. And we are not replacing ourselves at the appropriate rate to even survive. And there's entire countries that are going to be non-existent here in a short while because they don't, they're not replacing themselves. And so I don't know what it is.

I don't know if it's toxicity. I don't know if it's the metabolic health. I don't know if it's all the things all jumbled together. But we needed an escape signal, right? And so for me, it's risk tolerance. It's like some of these folks are headed down a sure path. They're living a sub-existent miserable life anyway, and they're headed down a sure path of demise, probably early death.

And a lot of folks are getting their lives back. And so I have that conversation with people. And I say, this is the risk tolerance, right? We're still going to do all the things. There's no getting out of that. You're still going to work, your butt off. But I have a tool that might actually make this a lot easier and more efficient. The long-term risks, I leave that up to the patient.

We don't know. We do know. I mean, we have had Lyrugetide and Exenotide out for a long time. And nobody's dying of cancer from those. And the data is looking really good. It might be dose-dependent, right? It might be dose-dependent. Like, I think, you know, why I like the way you think about things, Tina is because you're talking about personalizing treatment,

and not one-size-fits-all dosing, not massive super physiological doses, just enough to do the job. And my guess is you're going to get less GI side effects, less gall-bloodl issues, less pancreatitis, less, you know, issues around diabetic retinopathy work we're seeing, or even this new sudden vision loss, which is quite scary for people. All these things that, you know, the nutrient deficiency, if you're really conscious about how you do this and do a lower dose, you might be able to avoid a lot of these. Is that fair to say? Yes. And if you continue to work your butt off, you can stay on the lower dose. I find that to be true. I find that the minute people start slack in and they bring the alcohol back on board

and they're eating out all the time, they're going to have to bring up the dose because the weight loss stalls if they're truly after weight loss. And so it's a, it's just like anything else. I'm always just having an agreement with a patient. We're in a journey together. I'm the cheerleader. I'm not just the drug dealer. Like we're really trying to overhaul their life completely.

And I think that as long as they know going in that that's the deal, I will not. I mean, there's just no version where you should be allowed to take a GLP1 and not be in the gym. Like you should have a prescription and you should hold to it. Just getting people to hold to it is the hard part. True. It's tough. And you really have to understand what you're getting into. This is not a, you don't embark on this and not be prepared.

You know, you've really got to do it. It's really easy to dose yourself into Anhedonia. where you're just like all of a sudden you lose all your luster for life and then you just want to sit around. Patients are patients on higher doses. The study came out showing they just don't move around as much because I think it's because of that. I think they kind of get into this malaise state and a little too much can be a lot too much.

And so really working with somebody who's going to monitor you and encourage you to do all the things and help you get the resources to get there. Well, I think that's a really important point you make because most people are on the prescription versions. And what you're saying is, is it at those, doses, we're seeing people's emotional range blunted, dulling their joy, causing no apathy, what you call it, Anhedonia, which was not having fun. I mean, is this related to the dosing issue? Is they related to just the compound itself? I think it's a dosing issue because the second

you back them off, just a little bit. All of a sudden, actually I've seen people stall, and I've heard other doctors talk about this, they stall out at higher doses, and you actually bring their dose down and they start losing weight again. So there's a sweet spot. There's a very particular individual sweet spot. I was just talking to my best friend who she started out microdosing. She really needed to bring the dose up to somewhere in the middle of the, you know, ladder to really get the weight to come down. And she, that's fair. And she's really doing all the things.

But she messaged me and she said, I took just the tiniest. I mean, she went from like 7.5 milligrams up to 8 milligrams, just a little tiny bump. And suddenly she's flat as a pancake. Her affix flat. She hates everything. She doesn't want to go anywhere. She doesn't want to do anything. And I was like, you dose your, you dose into soul crushing dosing.

That's when you're, it's crushing your soul back off a little. But then also, you know, don't slack on the gym and make sure you're dial it, you know, maybe decrease the wine a little bit. You know, that's just how it is. And so it's not a get out of jail free card. You know, you still got to put all the pieces together. Are there things in the last few years that have emerged that we should know about it that are concerning? And is there any kind of new insights around that?

Or is it still the same kind of list of things? No, let's talk about it because there's actually some really good data has just dropped very recently. So the first one, I think we should talk about the N-A-I-O-N. No, I know, the vision loss, yeah. The eye stroke. It's non-artoritic anterior ischemic optic neuropathy. I have to read that off of my notes because I can never spit it out.

But study just came out July, 26, JAMA, ophthalmology, basically showing that it's an increase of about 300ths of one percentage point. It's very, very low. And what they really wanted to drive home in that study was that we're already talking about sick people living with diabetes for the most part is who they were analyzing. And so when you, and I did a podcast about this when the scare first emerged, and you know this, but for your listeners, when you take somebody who's been living with diabetes for a really long time, their entire vascular system is messed up. Really messed up.

And when you remove, when you drop the glucose too fast using medication, if you go, again, too fast, too hard, you know, maybe the dose is too high and too strong. The vascular can spasm. It doesn't handle it well. You have to titrate them up. You can't just wamp them with a dose. And so I do think that we, it's a signal. It's totally worth paying attention to.

I'm not discounting it. But again, it's just more, it's just more support for what I've been trying to say is we have to look at an individual dose. plan and we have to get them what they need and do it in a careful stepwise manner while they're being monitored because we don't want that happening. We don't want to send somebody's blood sugar plummeting when we could just gently nudge their system back to a more normal state, healthy and normal. So we were talking about a JAMA study back in 2024. It was a 2023 study that came out and it looked pretty bad. But actually when you broke that one down,

all it showed that when they looked at the numbers, they were giving you relative risk, not absolute. And so they were giving you relative risk reduction versus absolute. It's kind of how they played out with the intervention of 2021. You know, numbers get different and inflated. So anyway, that study, even when you broke that down, it was only two pancreatitis cases of semi-glutide users. Of over 600 people, there were two pancreatitis cases, which we know pancreatitis.

is a real risk and you're seeing it. And then there was 71 pancreatitis cases in about 4,000 patients, which is also, I mean, worth paying attention to, but this new study came out in gastroenterology in 2025 and it was a better done study. And the finding was no significant increase in pancreatitis, bowel, inflammation. So interesting, not to say it's not happening at all, but it wasn't enough to be significant. And so I think just to piggyback on the end of that, if you are continuing to eat and crush down high fat foods and simultaneously you are dosed to a place where your appetite is so suppressed that you kind of stop eating or you slow your eating way down, your gastric motility is going to slow down when you stop putting food into the tube and your

gallbladder is going to get sluggish. And these people probably already have sluggish gallbladder. They're already at risk for pancreatitis. They're all in the most of the people taking these medications are already having a lot of issues in the billiary gastric, you know, region, pancreatic region. It's already a stressed out system. And so now maybe instead of eating, you know, a big meal full of high fat fried foods, maybe they're eating a smaller amount, but still the body's not handling it well. They throw a stone. They get pancreatitis. So I just think it's, yes, again, it's a signal and it's worth noting. And you're seeing it. I know people, I hear it from my followers that they have seen it too,

maybe a loved one's experienced it. Just more reason to, like, do this right. There's a right way and a wrong way to do it. One of the things I talk about constantly with patients is the idea that the body isn't broken. It's just not getting what it means to do its job. That's really the whole promise of functional medicine. We're not playing whack-a-mole with symptoms. We're asking what do the underlying systems need to actually function?

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Let's move on from the side effects and the scary stuff because, you know, I think I've changed my opinion over the years on this. At first I was very against them and I was really skeptical and I've changed my position because I've been following the research. I understand the complexity of dealing with people with metabolic health. Yes, if I got people to do it my way, I think we could get most of the benefits in terms of, you know, functional medicine, gut healing, you know, understanding food's medicine, how to, you know, give people a lowlycemic diet set reset their metabolic system.

I've done all this. I've seen, you know, cured autoimmune diseases and cured dementia and reverse diabetes, reverse heart failure and reverse fatty liver and all these things are possible. But it's, it requires quite a bit of work. And it's not everybody who can actually do this. And I think these are, I think, a real benefit to humanity. The question is how do we use them right? So that said, I think I want to kind of dive into what's the difference between men and women taking these compounds?

What's happening around post-menopausal women? What about fertility? This huge fertility crisis related to what used to be called PCOS, but it's other things as well, metabolic health. And now they're calling metabolic reproductive syndrome as opposed to polycystic ovarian syndrome. and I'm so happy about that because I've always said it's not an ovarian problem. It's a metabolic problem and it's people confuse it. It's a kind of collogic issue and it's not. So anyway, what's your perspective on, you know, this kind of hormonal facts and what's

happening in these cases? Because I think this is a big issue. One in seven couples are infertile. It's kind of, it's a big problem. I think it's been miraculous because it's improving metabolic health. So men are experiencing improvement in testosterone levels. they're experiencing improvement in fertility. Women are experiencing improvement in fertility.

There's whole Facebook groups that are dedicated to like Monjaro babies. People are getting pregnant on the GLP 1. That's still being, you know, we're still deciding if that's safe. I think I saw just a few weeks ago position paper. Something came out. Don't quote me. I saw it in passing and I did not. I have not gone back and scrutinized it.

But basically they're saying that we're not seeing adverse events of people who were on these got pregnant, their offspring seems to be normal and healthy. So we don't know, of course, and we can't do studies on pregnant women, but people are getting pregnant and having babies when they were normally infertile and having issues. And so I think they're great. I think with PCOS or PMOS, the new term, I think it's great. I think it's, it works so great. I will say, though, I have seen with a couple of patients, young women with PMS, if they're really androgen dominant. If they go in really androgen dominant and they're already dealing with some hair loss and they're already dealing with some issues around that, it's a, it's

really critical that we onboard them slowly and carefully because I think that GLP ones can put a mirror in front of anything you're already dealing with. So if you're already hypothyroid or you're already low in hormones or you're already, you know, imbalanced in your hormones and you start throwing GLP ones at it, I think there can be a breaking in period that's very, very, very uncomfortable for people. And so ultimately, people do feel improvement in their thyroid health, and they do feel improvement in their PMOS symptoms. I had a young gal. We had her on a microdose of semi-glutide. Her hair started falling out like crazy. The androgen excess symptoms got way worse. It was a really, I mean, she could not tolerate it. She was not going to continue.

And yeah, sure, there was work to be done and foundational work to be done, but it did not go well. and I've seen this a few times. So all that to say, and I get messages from people saying, I just couldn't tolerate it for whatever reason. All my hair started falling out. So I think it, and there was one study. It was small. I can't remember if it was on rodents or humans,

but it showed that GLP ones can maybe exacerbate that androgen excess picture a bit. Maybe temporarily, we don't know. But I think that's worth noting for practitioners listening or patients out there because some people are having a really hard time as they start. and they're like, why isn't this working for me? I don't think, I don't think they're for everyone. But I do think overall, yes, we, I think this might be a big helper in the whole problem because we do have a fertility problem.

And then with middle-aged women, I think it's just fantastic. I mean, it's just a, I'm living it right now. I am in the throes of the sudden belly fat, right? And they say, oh, middle-aged women are going into menopause, the menopause transition with they're just low muscle mass and that's the reason and everybody wants to blame it on that and their metabolism isn't slowing down. I went into perimenopause in the best shape I've ever been in my life. I was training for a strong first kettlebell competition. I had more muscle on me than like most women in my, like I was like in the 1% of women my age. I was incredibly fit when I went into that

and I still got hit with the belly fat and the midsection and the visceral fat. And so I think what I just had a really great conversation with my friend Kieran Krishnan, who's a microbiologist and a GI specialist, and he was telling me that what happens with the shift in hormones during the midlife transition has such a huge impact on our microbiome, and it also has a huge impact on our lipopolysaccharide levels. And when those elevate, they cause your fat cells to expand and to get bigger. So a lot of what's happening in this shift is coming from the gut, first and foremost. And the really interesting part just to like put a, you know, put a big blob of whipped cream on top of that is here's the crazy part. When you start stalling out the gut with higher

and higher doses of GLP1s, you exacerbate SIBO. I think a lot of people are coming in with SIBO, which is small intestinal bacterial overgrowth. I think they are getting SIBO along the way. I think it is, even microdosing exacerbated my SIBO when I had a really stress, a huge bout of stress like boom my CBO was like not happy so that culmination and I read one study it was like a 45% increase in CBO with GLP1 users and I again I I wonder if they came in with it who knows but here's the ironic part Cbo pushes your LPS levels up and LPS is what drives obesity and type 2 diabetes you like that's lipopolyaccharides which is a toxin from bacteria in your gut that gets absorbed and it creates inflammation that inflammation is great insulin resistance which then creates

you know, weight gain diabetes and the rest of the cascade. So that's, that mechanism is pretty well described. So yeah, that's interesting. So the medication they're using to treat the obesity and the type two diabetes is in fact driving potentially the obesity and type two diabetes. It's, so this is where I think an integrative approach is non-negotiable. Like you have to treat the gut. I've gotten so many people better for metabolic issues by treating their gut. It's quite, it's quite effective. A hundred percent. So Tina, let's talk about what people should think about before they want to start JLP ones and what kind of blood tests or metabolic markers. should people look at before prescribing.

One of the first things I noticed with GLP-1s is that your labs will start to shift, sometimes even before the weight loss starts coming down or even if we're not going for any weight loss whatsoever and we're on a small dose or tiny dose will get great improvements. So I want to see those. So I want to see fasting serum insulin. I want to see hemoglobin A1C. I want to see C-reactive protein inflammatory markers. Obviously we run a complete blood count and a complete metabolic panel.

So we're looking at liver and kidney function from the start to make sure nothing's shifting there or going in the wrong direction. We might throw in some nutrients in there. I am concerned about malnutrition with these. I think people malnourish them, get themselves malnourished. And a study just came out showing it's all over the internet right now, like brain damage from GLP1s. It's not brain damage. These people are sitting on the edge of a thiamine, a B1 deficiency, which is super common. And then they get thrust into malnourishment with the high doses.

and then they go into, we're Nikki's encephalitis, and they end up with terrible, Frank, B1 deficiency issues. So people should take, check their nutritional markers and vitamins and minerals and get replete, like take a multivitamin along with it. And look at your lipids, of course, and look at your thyroid markers and just make sure everything's staying cool. I think with middle-aged women, it's important to look at, and men, it's important to look at your hormones.

I just, I run such a comprehensive panel on everyone. I hear you. I hear you. I mean, honestly, I agree with all you're saying. And I think that, you know, most people should check all those things anyway. And I think it's part of why co-founded Functional Health, which is if you'll access in a very affordable way to a very deep panel of blood work, which is all those things you mentioned, including nutrition, hormones, thyroid, cardiovascular markers, metabolic markers, renal markers, body liver, all of it. And, you know, it's just basically a dollar a day to get this done twice a year. And I think, I think it's important for will track things while they're doing it, to see the changes, monitor things. I'm super important. All right, let's talk about the kind of newer therapies and next generation therapies. And also, let's dive a little bit into the sort of microdosing framework because it seems like

the drug companies themselves are understanding that their doses are too high typically and that they want to give the possibility of adjusting doses by different sort of offerings that are having like vials or different pens that have titration ability on the pen. So can you talk about what's happening, what's coming, and how do we think about the dosing both? Because there's this whole gray market of people just buying them online or from mills or telehealth, and it's not actually probably safe. So can you kind of walk through how do people navigate this? We're listening to don't want to take the full dose or trying to figure out how to look for the right approach.

So the dose really depends on the person and their genetics and all the things we just mentioned and what their goals are. What are their short-term goals? what are their long-term goals. I will say this. Microdosing, the way that I originally introduced it was just a fifth to a tenth of the standard starting dose. And I would dose up to the, you know, the bodybuilders know this, right? The bodybuilders are the original biohackers.

They understand this concept. It's the minimal effective dose to move the needle of whatever needle we're trying to move. So maybe someone doesn't want to lose any weight, but we want to get their inflammation under control or we want to get their joint pain or there's psoriasis or the psoriotic arthritis, whatever, their eczema, their acne. It's the minimal effective dose. And so that is, I have found totally different for everyone. You asked me about men versus women. Men, I find need a higher dose. Women are more sensitive to it generally, but maybe that's just based on body weight. Maybe that's just size overall. And their hormonal status matters. We've got one study, it was small, but we've

got one study looking at terseptide and gLP ones, and they did better when they were on HRT. They had more appreciable weight loss. There was a small study. study done a couple years ago. I think we mentioned it on the last one. It was such a tiny study, but again, people who were on GLP-1s did better with weight loss when they were on HRT. So I think the whole milieu of the patient really matters there. And I want to be very clear. I never intended microdosing to be a weight loss strategy, but that's all it's being marketed for. And these companies are preying upon middle-aged women telling them they're getting a microdose and they're actually getting a standard dose. They're just being started at the first tier of the same dose that,

that the folks with diabetes and the same folks with obesity get started on. And they're told it's a micro. And it's an onboarding strategy. It's like drug dealers who give you your first dose free or whatever just to like. So that's kind of scammy. I've even had, I've got people arguing with me in my comments saying, no, I'm on a microdose. And I'm like, no, honey, you're like on the third tier up of the standard ladder. Like you're not on a mic.

But my doctor said what they tell him is, yeah, we follow Dr. Tina's protocol. it is one-tenth of the dose, and they tell them what the max dose is. And because they're giving them one-tenth of that, then it must be a microdose. So that's super unethical and scammy to me, but that's everywhere. And that's what a lot of these companies you're seeing, especially the telemedicine ones are doing that I found. So that's frustrating. And then I just want to, there was a study that came out in May of 2026.

I don't know if you saw it, but they looked at, they did a study. They looked at 49 different online telemedicine GLP1 websites. And this is scary. But this 49 is scary in and of itself. Yeah. We started a whole craze with that last episode. 17 sold compounded only, five sold branded only, and 27 sold both. Two required blood work.

One denied a prescription based on internal data indicating an existing prescription from another website had already been filled. And one prescribed but later withdrew the prescription due to a mismatch between the patient's photo and reported weight. But basically, 39% asked about weight loss goals. I'm sorry, 39 of the 49 asked about weight loss goals. And on and on it went, they did not screen these people very well. And only 13 required a video visit and three required a call. So basically you can go on, fill out a form and get GLP ones sent to you is the end of the.

And they're not doing a comprehensive workup on you. Not all telemedicant companies are like this. Some are really good. But yeah, this is pretty scary. And then the other option is the gray market, like you mentioned. And I mean, I think that's just gotten completely crazy. And I don't know what to say about it anymore. I don't have an opinion because too many analysis are coming out showing there's nothing in the bottle or there's contaminants or there's LPS.

Exactly. Which is concerning. Yeah. But the cool thing is, is the brands Eli and Novanortis released their vials. I don't know if you know this. The week that Eli Lilly released their Zepbound vial, I got de-platformed off Instagram at $232,000, because apparently they didn't want me talking about what I was talking about.

Really? Yeah, but I don't know. It's just coincidence, maybe. Anyway, they release their vials, and I think these vials allow for more individualized dosing, and from what I know from my colleagues, that's what they're using. They're using it to microdose. They're using it to a standard dose.

They're using it to half-dose. So now if you go to your doctor, they can actually prescribe these drugs from the, pharmaceutical company in a vial that allows you to self-administer with a syringe at a lower dose. So it's not an auto pen. Is that the idea? Yep. So it's personalized, individualized dosing so people can onboard. The paper came out in the journal of diabetes in 2025, I think, or end of 24, talking about microdosing GLP-1s, but the way that they talked about it was, it was published. It was an opinion paper. It wasn't a study. But the way they talked about it was

individualized onboarding. So they're talking about microdosing differently than I am, and they're talking about using it to get your patient up to the appropriate dose, but you can start them lower if they need it because people definitely need it. A group out of Italy was reporting that, you know, they're finding a lot of success with individualized dosing. I think doctors are getting it. I think doctors are realizing we're all different sizes and shapes. We all need a different individualized strategy. But the, I do know that Monjaro, I believe, came out recently in the U.S. with not just the standard auto pen, but the clicky pen, it's, you can dial the end. And this journal of diabetes paper did give you a whole chart on, and I know that's available in Europe, a whole chart on how to

change your dose or your patient's dose based on how many clicks you do. So it's called the click pen method. And so that's, we got, we've got a lot more options than we did last time we talked. And the prices come way down. So the good news is you can get them from legitimate pharmaceutical manufacturers, you can get them at lower prices. The probably the truth is that the prices are higher with these pharmaceutical versions than the ones that are maybe able through other markets, right? I think it depends, actually. The compounding situation with JLP ones is so hairy right now that I've seen prices kind of all over the board. And some of these companies really gouging, some of these telemedicine companies really gouging patients. So I don't think so. I think the, I think

Medicare just got, you can do a Medicare program now, $50. If you go through Lilly Direct and get the Zepbound in the vials, the pricing is quite it depends on your dose. I don't know. And I'll say, though, the clients, I've got a few clients I work with who are getting prescriptions from their doctors, and the Zepbound seems to be working better than the compounded for them for weight loss. Or the other thing to consider when weight loss stalls is you just just

change your injection site. And so a lot of people will get comfortable kind of sticking to the same place all the time. Maybe it's the outer buttocks or the thighs or the belly or the arms. And so something that was my friend actually just mentioned it to me. She's like, oh, I just started rotating my sights and the weight fell right off. And I was able to back off that dose that was sucking her soul out. So she, yeah, so there's just a lot of variation here. I think we're learning. And It's fun to be able to talk with you and have a fun conversation about it that's educational so people can get all the information. Yeah, it's good. I mean, it's evolving.

And I think people should really work with a reputable practitioner, understands how to use these in conjunction with lifestyle, doing the right diagnostic test beforehand, understand what's going with your metabolic, nutritional health, hormonal health, and kind of monitor things like dexas scans and your bone density and your body, you know, muscle mass and really tracking things. Because I think without that, it's a very slippery slope. I agree. I want to end by sort of doing some rapid-fire questions. Are you up for that?

Yeah, I'm ready. Okay, so you mentioned alcohol and how it might interrupt the cravings or addiction in general. What's the deal with alcohol and jump who wants? Can people drink? Can they not? How does it work? I would get off the alcohol. I really would.

When you slow down gastric emptying, the alcohol stays in your stomach longer. So what you're used to consuming and thinking you can handle changes. So if you think you can handle one or two drinks and get in your car and drive, you can't anymore. It's also a poison. It's poisoning your mitochondria. And your mitochondria being poisoned are part of the reason why you can't lose weight. So it's kind of an oxymoron. If you're going for weight loss, it's really you're shooting yourself in the foot with alcohol on that one.

Find other drugs. All right, got it. What about mistakes people make on GLP ones? I think what we talked about, just using it as the. plan, you know, like using it as the solo monotherapy plan. Like that's, I'm going on Ozempic or whatever and that's it. It's like, no, no, no, no. It's, that is a but one tool in a comprehensive toolbox and you really have to do all the things. And what's the biggest misconception people have about this medication? That they're eating your muscle and bones. It's not true.

Well, you will lose muscle and bone if you don't exercise, but that's because any weight loss will do that, right? Yes, yes. Okay. What's the thing everybody should know before starting them? That what you just said, that you should work with a reputable clinician who knows what they're doing, who understands, you know, integrative functional medicine does a comprehensive treatment plan. I think that's key. And I know not everyone can access that, but at the very least, go to the freaking gym and start eating nutritionally dense foods. Start there. And who shouldn't take these GLP win drugs? I'm really concerned. I live in north of Scottsdale now, and I'm seeing all these weight loss clinics. And they're treating little old ladies who have no weight, who really have no right losing any. weight. As we age, that little bit of extra weight might actually be protective. And these women are worried that they're fat. And so they're taking GLP ones. And I just had one of my friends, his grandma fell down and fainted and almost broke her hip and was in the hospital because she, they're already

headed towards frailty if they're not going to the gym regularly and they're not protecting their muscle. And then they've got GLP ones on top of it. I think it's crazy and super unethical. So be careful and older people who aren't really obese. That's what you're saying. And young women, who are not really obese, who are using it for vanity, weight loss. It's not a vanity drug. I mean, people are going into trouble. I agree. What's one lab test to which doctors paid more attention to related to all this? Serum insulin. Hey, I knew you were going to say that. Oh, man, I used to catch hell from my colleagues. And they're like, why are you testing everyone serum insulin? You think everybody's metabolically compromised? I'm like, they are. And here we are.

No, it's terrible. I mean, I went, I was, been testing insulin for 30 years. And I just talked to the, the lab guys at Quest, who is our function to help partner. And I said, what percentage of tests that you get are,

including insulin, an order? It seems like less than 1%. I said, I was talking to the dean of the medical school in Arkansas, Bentonville, the Alice Fountain School Medicine,

who's of East Indian descent, And she's a doctor and she's actually a fan of mine. She was listening to my podcast. And she's a guy to college oncologist as her specialty, but she's the dean of medical school. And she went to see her cardiologist and said, will you please order an insulin for me? He's like, no, you don't need it.

And she's, yeah, but I'm in. And I find out this is a problem for me. It was quite amazing how it's one of those tests that is so simple, so cheap, so easy to do and tells you so much that nobody's doing. And if you take one thing away from this podcast, you've got to get your insulin down under 10, ideally under five. And that's what a lot of this stuff will help you do. Okay.

What's the most surprising thing you've seen happen to a patient that had nothing to with weight loss with these compounds? Oh, gosh, just the addiction piece. I think, like I mentioned, the eating disorder, I'll tell you one. Me, I was taking a microdose of terseptide. I was wearing a CGM. My blood sugar is dangerously low all the time, like so low that it sets off the the device and it alarms you know the alarm goes off when I use gLP ones it puts my blood sugar back

in the normal range isn't that and I've heard and I've asked many people and they have seen similar so yes it's like a paradoxical effect almost yes yes and then the addiction part and the eating disorder part I think those are things we didn't expect okay that's good those are important things what's something people don't worry about with these drugs that they should worry about their muscle particularly their lower body. If you're going to lift, if you're going to take a GLP when you have to lift, and if you are going to go spend time in the gym, you really have, especially you ladies, as we're aging, we are protecting our bones and our muscle.

And you have to lift lower body because it's your biggest metabolic sink. That's the biggest bang for the buck. Everyone's so, you know, obsessed with these Demi Moore arms. And I'm like, can we just build a dump truck? Like, we need to build an ass. Like at the end of the day, that is what's going to protect you from a hip fracture. You have to go to failure and you have to progressively overload. So find someone that can help you learn with that.

I talk about it all the time on my social media, my podcast, but that's critical. Agreed. I agreed. Agreed. I was doing that this morning. My butt hurts. Good. So what's one thing the internet has completely wrong about you if you want?

They're made from snake venom and they're going to literally directly derive. There's a doctor out there, chiropractor saying, and I'm a chiropractor too, so no shade, but every single prescription is derived from, it has venom in it. Okay, how about one thing that you would change about how these meds are prescribed today? What would it be? Oh, I think it's just the Wild West. And I think people have, I hate to say it. I'm such a libertarian and I believe people should have access to medications without too many hurdles.

But I think it's just too crazy right now with the gray market and even the telemedicine companies. And then really just my concept of microdosing being bastardized and twisted into some vanity weight loss thing. It was never intended. And it's kind of where we're at. So I think that's a way off base. But also, you do say that the microdosing does help with weight loss too, though. And that just says... Well, a half dose, I mean, a half dose could.

If someone is really metabolically optimized, it can lead to, you know, 10, 15 pounds of sort of that inflammatory puff or that middle-aged kind of like that menopausal insulin resistance weight that comes on. I think it can help with that. But I think if you're looking at the average middle-aged woman who's looking for weight loss with a microdose, she's probably looking at more of a standard dose or a half dose or three-quarters of a standard dose. I'm not talking to like micro-microdose. Like I have little old ladies on tiny little doses for their joint pain, totally different beast. What's the biggest unknown we're trying to answer?

Well, like you said, what is coming in 20 years? And I am concerned. I think we're going to see there's like quad and, you know, there's. There's like the five different agonists, the four, they're coming out with all kinds of fancier ones. And I'm seeing a lot of people who have gotten to the top tier of dosing. They're still living with obesity. Maybe they're not doing all the things.

Maybe they are. I'm not judging. But they're looking for the next medication to come out because they've peaked. And now they're gaining weight back. And so I think we're going to see this with a lot of people to your concern and mine, just kind of running to the next one. and it's just a long line life of kind of being tapped into a drug. It's a scary thought, honestly.

I hear you know, it is. It is a wild west, and it's like there's a quote I always talk about, which is from the New England internal medicine that said we should use new drugs as soon as they come out before the side effects developed. We don't know. Okay, so on the positive side, what's the most exciting GLP1 area of research now? Cancer. I think it's really exciting to see. There's two studies that came out recently showing potential prevention with, and it's not causative, it's correlative from what we have. It's observational,

but breast cancer. But to your point, when you optimize metabolic health, then, I mean, I remember being, what was it, the year I got my medical license, it was like 2008, and I was downtown Portland and the Susan G. Komen walk for the cure was happening. And it was all of these little cute ladies in pink t-shirts with fairly girthy midsections carrying boxes of voodoo donuts and drinking giant Starbucks Frappuccino's. And I was looking at my, it was a bunch of nature paths up in a room at a conference and we're looking at the window and I'm like, this is, this is not it. This is not it. This is why we have breast cancer. It's my. It's metabolic health. So I'm excited to see that benefit play out. But at the end of the day,

we got to treat the root cause. Amazing. Well, Tina, thank you for keeping your eye on the ball, for helping us a big, complicated field of weight loss, metabolic health, GLP-1s. I think it's really such an important, but also is fraught a little bit of risk. And I think doing it right is really important. And hopefully, those you're listening, and figured out how to do it right, and where can they find more about your work, Tina, and learn more about how you think about all this. Yeah, well, thank you again so much for having me back. I appreciate it. It was nice to be able to just talk with you one-on-one and get the information out, doctor-to-doctor. So I have a community I'm launching. I'm so excited about it. You can actually access me in there and I can give answers.

It's for middle-aged women. It's called the Menopause Rebellion. And so that's at school-S-K-O-O-O-L.com forward slash Dr. Tina. I have a podcast, the Dr. Tina show, and everywhere you can find me. DRTYNA. And that's my website too, Dr.Tina.com. Great. Thank you. Thank you so much for just keeping on this and helping us all understand. It's very messy, complicated to you. Thank you so much for having me. It was fun.

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on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am chief medical officer. This podcast represents my opinions and my guest's opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at Ultra Wellness Center.com and request to become a patient.

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