GLP-1 Medications: Separating Hype from Health and Navigating Real Medical Use

GLP does not differentiate between fat and muscle. You lose them equally if you don't take right measures. If you're not taking enough protein or if you're not doing a registrant training, you're gonna lose a lot of muscle mass, which can lead to you know so many other problems. Besides that, if you are not focusing on right nutrition, you can also have some nutritional deficiency, and that can lead to you know hair fall, patients also feel very fatigued. These are the some of the overlooked side effects.

So I'm super excited to hop into this episode. I hear about Ozempic and all the GLP1s all the time, like everyone else. So, doctors saying, I'm glad that you're here. Let's clear up these misconceptions. And before we hop into anything, how are you doing today? Are you excited to be here and talk about this?

I am super excited to be here, Leila. Thank you so much for having me here.

Absolutely. So, GLP ones, like I said, are everywhere right now. They're talked about at dinner parties, they're in the news, they're on social media, and everyone seems to be talking about that, whether they're with friends or online or it's just everywhere. So it's hard to figure out where to really start separating the fact from the noise. So, where do you think we should start even separating the fact from the noise?

Oh Lila, I'm so glad that we are starting with this question. Um, you know, I tell everyone that GLP1 agonists, they are the medication of this decade. But we uh, you know, I want uh to start by stepping away from the social media and the noise that we have created around the GLP1. And remembering that these are the real prescription medications. They are not beauty treatment, they are not quick fixes, they are true medication. And these medications can be extremely effective for the right patient because there is a science behind them. They reduce appetite, they improve satiety, they uh, you know, help with your blood sugar regulation, and they also impact your cardiovascular and metabolic health. So the no but the noise I think begins when we hear a statement like, you know, everyone should be taking uh one of the GLP agonists, or on the other extreme, you know, some people are saying that, you know, the using medication is cheating. So I want to say that neither is true. I think the right question isn't whether this medication is good or bad. The right question is is it appropriate and safe for a given patient?

Absolutely. And I've heard both sides of it just from the media, obviously, and then working and having the pleasure of interviewing so many doctors. I think that what you said is exactly right. I couldn't agree more that it really is a medication that's helpful for the right patient. I think a lot of the noise comes from people who may not truly need it, who are taking it and maybe either misusing it or not using it in the right way that is creating some of that noise and that confusion. But what do you think is the original clinical purpose of these medications? And if you think that's shifted, how do you think that has shifted?

Yes, so GLP receptor agonist, you know, they were originally developed for diabetes management because these medications help to release insulin when the body is exposed to glucose or when the glucose is elevated. They also help to reduce our glucagon, they slow down uh gastric emphatic, and they also communicate with the brain, telling them that you know what, you have had enough to eat. So kind of, you know, working on a satiety center. But what happened when physician they use this medication for diabetes, they also noticed, you know, significant change in uh patient weight. And then, you know, more research done in this particular space, more data collected, and eventually FDA approved this medication for resistant obesity or you know, chronic uh metabolic syndrome where patients were struggling with weight management. So the performance has expanded. Initially, it started for controlling the blood sugar to now treating the resistant um weight or uh obesity and uh chronic metabolic syndrome. But one thing that I am uh seeing now, which is slightly alarming, that now it is shifting towards cosmetic use. Now people are you treating it or using it as a quick fix or as a you know magic treatment for the cosmetic purposes.

Absolutely. So what does responsible medically supervised GLP1 use really actually look like?

I think that's a very important question, Lela. And I uh start that at Eternal Wellness MD, it begins with full evaluation, which incorporates having a detailed medical history. So we start with, you know, what's a patient's dietary habits, how's his nutrition looks like, what's the exercise, uh, you know, whether it's a part of their daily routine or not, and also what's their stress pattern. We also look into how what this patient has done in past in terms of you know weight loss. And once we gather all these, you know, clinical information, we focus on biometric analysis. And biometric analysis doesn't mean that we check only weight or BMI, because we also look into percentage fat, um, we do the visceral fat analysis, we also look into muscle mass, uh, the abdominal girth, because these are some of the metrics that can be really valuable later on in uh you know managing or or assessing the progress on GLP1 therapy. So once we have that, we take also do a detailed um, you know, review regarding whether the patient has any contraindication or not. Um, you know, we know some of known contraindications, such as if you have any personal or family history of thyroid cancer or MENTU syndrome. So after doing that, we also want to learn what patient personal goal, because it is very important, you know, align with what patient personal goals are in terms of weight loss. And you know, sometimes it requires uh realignment in a way that they come with very unrealistic goal or the time frame that they want to reduce this much weight in this time period. So we also go in very detail what this medication can do and how effectively and safely we can achieve the goals that you know person has in their mind. Um after that, uh, we also run some, you know, the very common labs pertinent to um the obesity such as uh CBC, CMP, HBA1C, lipid panel. Uh these are the some of the thyroid, which is very important in women, you know, sometimes subclinical hypothyroidism can also lead to weight gain. So ruling out other possibilities uh causing you know weight gain. And once we have all these, then we start patient on a protocol. And even when we start patient on GLP1 agonist, we also create a parallel plan regarding your their nutrition, their exercise program, uh registrant training, sleep, bar regulation, and follow-up. And we also create a regular monitoring, um, you know, the how we're gonna do that. Because we don't primarily focus on pound loss, we focus on the base circumference, we look at the metabolic markers, we look at strength and overall body composition. So let me share one example. So one patient came to us and uh she was she came with that I want to lose this amount of weight in this much time frame. So um our team sat down with her, and as I listed earlier, we took a detailed history, we did her biometric analysis, we ran certain uh lab tests, we ruled out all contraindication, and when we found that she was the right candidate for GLP therapy, then we created the whole plan. So uh, you know, initially she was skeptical. She thought that we are not uh, you know, um rigorous enough, but when we started the protocol, um she loved it. The reason is, yes, she didn't lose the uh pound that she wanted to lose in a given time frame, but the journey was so easy for her. She was also scared when she was starting the treatment because she heard uh about all the side effects. Some of her friends took the GLP and they encountered all those side effects. But we uh truly monitor her progress and we looked into how she was tolerating those medications. And while doing that, we also focused on her nutrition, her protein intake, her um the exercise program. So at the end, you know, you know, she not only lost weight, but she felt more energetic. She felt like uh like the vitality that she was looking, and she really felt like she said, This is the best I ever felt in my life. So I think that's very important that you know the whole GLP journey should be, you know, medically supervised and personalized.

Absolutely. And I think that, like you said, having that supervised program and individualized for each person is how people really are using the medication in the right way and really benefiting it from it. I think that a lot of the noise and the confusion comes from people, kind of like we touched on early, maybe misusing it or not using it with a provider who's actually coming up with a plan for them. For example, I had friends who have taken GLPs and I've had friends who have done it through doctors. I've had friends who have got it from group on, if I'm being honest. Like we all know these stories of people taking it the right way or perhaps not taking it the right way. So I think that that's a big part of really taking it the right way and reaping the correct benefits from it when you do it with a provider and you have a plan and you might not lose it exactly, like you said, with your patient who may have taken her a little bit longer to lose it, but I'm sure her results are better. She'll probably keep the weight off. Some people lose weight really quickly and suffer the side effects, and then they kind of gain it back. I personally know I have a friend that's that that happened to as well. She lost the weight, she was super sick, had a lot of the side effects, and then gained some of it back. And then I know people who did it the the right way, as if you're like what you're describing, and they feel good, they kept the weight off. It became more of a lifestyle change. But speaking about that, what do you think some of the risks or some of the downsides that people really aren't hearing enough about when it comes to these medicines?

Yes, Leila, there are some known side effects that most of the people know uh that is primarily GI side effect that some people encounter nausea, some have vomiting also, or constipation, diarrhea, gastric reflux, some of them can have, you know, mild abdominal pain. But these are primarily dose-dependent, and you know how you titrate these medications. So if you titrate them slowly, uh the someone can, you know, control these side effects. Um some of the serious side effects, such as patients can have pancreatitis, they can have gallbladder diseases, or you know, if they have intractable vomiting, they can have dehydration-induced kidney injury and those things. Um, the other thing that, as you know, the GLP, it they have a black box warning of um the thyroid C cell tumor that primarily, you know, it was seen in animal studies. Uh, so they are contraindicated in any patient who has a personal or family history of thyroid cancer or MANTO syndrome. But I think the area that has, you know, overlooked the issue that is becoming a big problem is muscle loss. So I always tell, you know, all my patients that GLP does not differentiate between fat and muscle. And you lose them equally if you don't take right measures. So if you're not taking enough protein or if you're not doing the registrant training to support your muscle and bone, you're gonna lose a lot of muscle mass, which is which can lead to, you know, so many other problems. Um, besides that, again, if you are not focusing on right nutrition, you can also have some nutritional deficiency, and that can lead to, you know, hair fall. Uh, patients also feel very fatigued, they feel they don't have energy. Um, so these are the some of the overlooked, you know, side effects. Um, let me share another story. You know, one um the one patient came to me, he took a medication from somewhere else, and he lost his weight very uh drastically or suddenly. So when he came to us, he was like he had no energy. He said he was feeling fatigue all day. In fact, he was not happy with his overall look. He has that, you know, that now we call it Osampic faces, that NAT look, that appearance you have on your face. Um, so when he came to us, I said, you know what, don't for let's not focus on medication dose or you know weight loss. Let's focus on the other things. So we definitely, you know, worked on his nutrition, added some real good protein to his uh diet regime, and we added some exercise program. We also gave him some support of NED and you know other peptides. And at the end, he was feeling, you know, very energetic. We also did some, you know, energy-based uh therapies for his hair call and all those things. And we did a full, you know, uh biochemical panel to look deeply, you know, what deficiency he was having. So um it it it is like you know, people don't realize that, people don't hear about that, they just focus on the weight loss part. But these are some of the downside of these therapies if they are not done, you know, properly in uh, you know, uh medical guidance.

Absolutely, and I've heard a lot of stories like that as well. And for example, my friend who lost all this weight super quickly, and like you said, the Ozempic face and all these different things as well. So, with with all of these patient stories that you're mentioning, and I'm sure at this point everyone has either had their an experience with GLP1 or a friend who has an experience with GLP1, and it sounds like so many people have taken them. But how do you really decide if a patient is actually a good candidate for this medication?

Yes, so uh at Etrinov Illness MD, we look at uh, you know, patient uh whole clinical picture. So, as we all know that FDA have approved weight management medication, generally for adults with the BMI more than 30 or 27 with other comorbid conditions such as hypertension, diabetes, cardiovascular diseases, or sleep apnea. But you know what? I I don't fixate on the BMI alone or weight alone. We also look at you know visceral fat, waist circumference, insulin resistant, fatty liver, cardiovascular uh risk, the mobility, sleep, uh so the how the weight is, you know, uh in totality affecting that person's health and quality of life. So once we uh you know screen uh for contraindication and we also look into whether, particularly for female patients, whether they have any pregnancy plan or not, whether this patient ever had uh severe pancreatitis or gallbladder disease, or whether they have any GI issue, you know, severe GERD, which is a gastric reflex diseases. Uh once we rule out all these and including, you know, other some of the other contraindications, such as I mentioned earlier, like you know, the thyroid cancer, personal or family history, we did decide whether this patient is the right candidate or not. So, you know what, um, and and the other thing we also incorporate when we decide whether someone is a good candidate or not, patient personal gold. You know, someone wants to loot uh like lose four or five pounds just for a wedding or, you know, a special uh event coming in their life versus someone is struggling with some medical disease that can be benefited if patients lose their weight. So we we look at the whole picture. Um, you know, we we I I again remember one patient came to us, she was uh elderly woman, um, and she was uh of course her BMI was high, but she had also had you know severe knee osteoarthritis. So what was happening that because of her weight, uh she was um having more pressure on her knee, and her osteoarthritis was getting worse. Uh but because of the osteoarthritis, she was not able to participate in you know exercise, to walk and all those things. So it was kind of creating a you know a loop for her. Her weight was worsening her osteoarthritis, and her osteoarthritis was leading her or you know, her not able to do the exercise. So we looked into the whole picture and we felt that if we can, you know, help her to reduce uh some pounds that can not only uh help with her osteoarthritis but well help her to move better. And once she moved better, she can have you know the stiffness and all those um uh things that she was happening because of osteoarthritis that can get better. So we put her on protocol and she lost some weight, and she was so happy that after losing those pounds, she was able to walk better, she was able to participate in you know physical therapy better, she was able to do follow the exercise regime that was given to her. So I think that is very important that we need to see the whole picture. We need to look the patient in totality rather than just focusing on pound or BMI.

I think that's so important that you pointed that out about the whole picture. And for example, someone who's been struggling with weight loss due to a lot of different health issues and things like that, versus someone who just wants to lose, let's say, four or five pounds for a wedding or an event or something like that. So let's kind of talk about the quick fix culture framing directly. So, what's the danger in really treating this as a shortcut rather than part of a broader plan?

Yeah. So you know what? This quick fix mindset just focuses on getting the weight off. While the good medical care, it asks how we will protect the patient's health while losing that weight and how we'll also maintain the result that we have achieved through the GLP one. So, you know, the as we all know, the medication suppresses the appetite. But if patients never learn how to eat adequately or move consistently or manage their stress or protect the muscle, then treatment remains fragile. You know, either um they become demotivated or because they develop so many deficiencies and side effects that they the compliance goes down. And most important thing, when therapy is stopped, the appetite may return and you know they can gain the weight again. So um, you know, I I remember uh the one of the patients came to us and she told us that, you know, because of the GLP one, her, you know, finally the food chatter, the noise she was having, uh, she was able to suppress that. And now that she has suppressed that food noise, she has created some mental space, a clarity where she can focus on nutrition. She can think about, you know, structured meal, having more protein, and you know, incorporating walk and other exercise in her daily routine. So, you know, the I always say that the medication, it gives us a window opportunity, but it's up to us uh, you know, how we're gonna use that opportunity to create some habits that can help us to sustain the results.

So, how does this fit alongside the foundational work that you've really talked about in earlier episodes? For example, sleep and movement and also metabolic stability.

Yes, so Lela, GLP therapy should support the foundation, it should not replace them. So, anytime if someone goes decides for a GLP1 therapy, I also ask them that the foundational piece goes along with that. Because we all know, as we discussed in previous episodes, that poor sleep can cause hunger, craving, insulin registrant, and at the end, emotional eating. On the other hand, if you have a movement, it can improve your insulin registrant, it can help with your cardiovascular health, um, the registrant training that can help or support your muscle and bone, and adequate nutrition can give you energy and recovery. So, you know, sometimes um the I as I just said earlier, that these medications make these foundational changes more achievable because they provide us that wing window opportunity where the things that were very difficult earlier to incorporate because of various reasons. As I said, that if you had a problem with mobility due to heavy weight, now that you lose weight, you can incorporate excess. Into your program. Someone whose hunger previously felt overwhelming may finally have the mental space to make intentional food choices. So at Eterna, you know, I always say that foundation first. Medication, you know, always comes after that. They are one of the tools, but foundation is truly that determine the quality and the sustainability of that given treatment protocol that we are putting in place.

Absolutely. And I think that this is an important question. So, what does an ethical conversation with a patient about these medications sound like in your practice? We've talked a little bit about the right people taking it and things like that. So when it comes to an ethical conversation between a patient and yourself, what does that sound like?

So it sounds honest and pressure-free. So I always tell patients what this medication can accomplish and what it cannot accomplish. We are very realistic about the outcome. We also tell them clearly about the side effect and you know the serious warning sign. The cost, the possibility of obesity may require long-term treatment. These are some of the other conversations that we always have with patients. And, you know, one thing I always make very clear that it is an optional. The patient should never feel sold a medication or ashamed for wanting one. So we discuss, you know, alternatives. What are the alternatives patients have if they don't want to go on the GLP1 therapy? And if we agree to go ahead with the treatment plan, then we also define the success. Because at the success is not only about losing weight. We also talk about the glucose control, the waist circumference, the improved mobility, and overall, you know, energy. And by doing that, how we can preserve their muscle mass also. So, you know, the ethical care is um means, you know, when it comes to ethical um practice, it doesn't mean prescribing the medication. It is about prescribing the right medication to the right patient and being transparent about um the whole process that sometimes also includes from where these medications are coming from. And patients also deserve to know what exactly they are taking, you know, the source of those medications. So these are some of the conversations that we always have at Returnna Wellness MD, and we always try to remain transparent about the whole process.

Absolutely. And like we touched on, there's definitely a lot of stigma on both sides. So the people who judge and the people who really see it as a miracle cure. So, how do you navigate that as a physician within your practice?

Yes. So, you know, I always try to bring conversation back to biology and uh do it with a lot of compassion. So, you know, the obesity, there are a lot of social stigma attached with that. We label obese people by saying them either they are lazy or we call them they are not disciplined, and a lot of times they are given these suggestions, oh, you know what, just eat less or go and work out more. But now the size has proved that the obesity is a complex medical condition. And sometimes, you know, patients are fearful to take medication because of the stigma attached with it. They think that it is cheating. But I always tell my patients that, you know, like the hypertension, when we treat hypertension, that is not cheating. When we treat diabetes, it is not a cheating. So why should treating obesity, you know, seen as a cheating? You need the medication because you have a medical condition. And once we put the whole biology in place, then the conversation becomes, you know, very easy. So uh we also tell them that the, you know, the GLP therapy is not magic. It does not automatically produce the good nutrition, strong muscle, or emotional well-being, because they have also do their part. They have to follow the regime that we are, you know, providing them along with the medication if they want the sustainable result. So I always tell patients, you don't need to feel ashamed of using a medical tool, but we should also be respectful that the tool enough to use it thoughtfully. Because as we discussed earlier, that these medications are also getting a lot of popularity in terms that they are the magic, you know, fix. So that is very important that we need to differentiate that these are a medical treatment that require close supervision rather than, you know, um treating them as a medical cure.

Absolutely. And when you mentioned that, I also had a similar thought that I've heard before about how it is a medical condition. Obesity is now being more so recognized as a medical condition than previously and previous times, rather, and really having this medication can help improve the quality of life for so many people. And for someone who is considering this path, what questions should they really be asking their provider before starting?

Yes, you know, I would like to encourage everyone, whenever you go to any physician and want to be on GLP1 therapy, the first and foremost question they should ask that why do you believe I'm a good candidate for this therapy? And you know, and after that, you know, ask about the science, whatever therapy, the weight loss therapy you are deciding to go on or you know to follow. I always say that look at the science, look at the data that is available that can support that given, you know, treatment regime. And uh once you decide, then also be aware about the side effect contraindication. So go over that in detail. And and once you are on the medication or you like, you know, very short that you're gonna do that, also ask, you know, what is the monitoring gonna look like? Uh where do you see yourself from now to you know coming six months? And whatever the results you are going to obtain or uh achieve in that given time frame, how are you gonna sustain that? Uh what is your winning plan? Are you gonna be on those medications for lifetime, long term, or you know, there is any plan to wean off that medication once you achieve your goal? Um, the some other question I always encourage patients to ask that uh the what happened if I have those side effects, how I am going to manage those side effects, and definitely there are some other questions uh these days have become very relevant. Uh, one of them is cost, and the other thing is from where this particular clinic is procuring that medication. So these are the some of the questions you know the patient should ask. And then I think the last and the most important question that how are they gonna maintain the results that they are going to achieve because of this therapy? Um, how are they gonna sustain those outcomes? Because um, we are seeing particularly those patients who are going for the rapid weight loss, the moment they start the medication, they gain the weight again. So these are some of the uh the question they should ask. And if the only conversation is here is your medication and come back when you need a refill, I cautious the patient that that's not the level of care uh they should go for. Um, they should pause and they should rethink about uh the whole treatment plan.

And then I have a good question as we kind of wrap up this episode, but if you had to really sum up your philosophy on GLP1 in one line for someone who's on the fence, what would it be?

So I want to tell everyone that GLP therapy is not a shortcut. It is a very powerful medical tool that works best when it is intentionally prescribed, responsibly supervised, and built on the foundation of nutrition, movement, sleep, and stress management. Because once you do that, then only you can have a sustainable and long-term metabolic health.

Absolutely. And then I think that this is a perfect example of what intentional medicine is really all about. And it's not rejecting new tools and not chasing them blindly either, but really using them with clarity and a real plan behind them. Dr. Singh, thank you so much for really cutting through the noise on this one. It's a super important topic. Everyone's talking about it. And if you're considering this path for yourself, we hope today really gave you better questions to ask and more clarity. Dr. Singh, it's a pleasure speaking with you as always. We'll see you next time. And for our listeners, make sure that you are following, subscribing, and sharing the show. And we'll talk to you soon.