
Next Level Human
As humans we have a job to do. In fact, we have four jobs: to earn and manage money, to attain and maintain health and fitness, to build and sustain personal relationships and to find meaning and make a difference. Your host, Dr. Jade Teta, is an integrative physician, entrepreneur and author in metabolism and personal development.
Next Level Human
Microdosing Ozempic (GLP-1 weight loss): A Safer Approach with Dr Lauren Fitzgerald MD- Ep. 272
Dr. Jade Teta interviews Dr. Lauren Fitzgerald, an MD specializing in functional medicine, about the use of GLP-1 agonists (semaglutide, Tirzapatide, etc) for weight loss. Dr. Fitzgerald shares her experience using these compounds and how they have helped her and her patients achieve significant weight loss. They discuss the history and mechanism of GLP-1 agonists and the potential risks and benefits. Dr. Fitzgerald emphasizes the importance of using low doses and implementing healthy habits alongside the medication for long-term success. Dr. Lauren Fitzgerald discusses using semaglutide for weight loss and shares her experience and insights. She emphasizes the importance of lifestyle changes, such as protein intake and weight training, in conjunction with the medication. Dr. Fitzgerald also explains her approach to dosing, starting with a low dose and adjusting based on individual response and weight loss progress. She highlights the benefits of using a compounding pharmacy and provides tips for maintaining weight loss after discontinuing the medication.
Keywords
GLP-1 agonists, weight loss, functional medicine, microdosing, safety profile, semaglutide, weight loss, lifestyle changes, protein intake, weight training, dosing, compounding pharmacy, maintaining weight loss
Takeaways
- GLP-1 agonists, such as semaglutide and terzepatide, are bioidentical hormones that regulate hunger and insulin sensitivity.
- Traditional dosing of GLP-1 agonists can lead to severe appetite suppression and potential side effects like nausea, vomiting, pancreatitis, and gastroparesis.
- Microdosing GLP-1 agonists, starting at 0.25 mg, can be a safer and more sustainable approach for weight loss.
- Slow and steady weight loss is more likely to be maintained in the long term.
- GLP-1 agonists have a good safety profile when used correctly, and concerns about thyroid cancer are not supported by evidence. Semaglutide can be an effective tool for weight loss when combined with lifestyle changes.
- Protein intake and weight training are important for maintaining muscle mass during weight loss.
- Dosing of semaglutide should be individualized based on the patient's response and weight loss progress.
- Using a compounding pharmacy can provide more flexibility in dosing and cost.
- Maintaining weight loss requires ongoing lifestyle changes and a gradual reduction in medication dosage.
Chapters
00:00 Introduction to GLP-1 Agonists and Functional Medicine
08:59 The Need for Effective Weight Loss Tools
12:38 Understanding GLP-1 Agonists as Bioidentical Hormones
17:24 The Importance of Low Doses and Safety Profile
21:21 Addressing Concerns about Thyroid Cancer
24:56 Introduction to semaglutide for weight loss
29:19 The importance of measuring data and non-negotiables
31:33 Using a compounding pharmacy for semaglutide
34:13 Benefits and success with compounded semaglutide
36:14 Transitioning to trisepatide if needed
40:32 How to work with Dr.
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All right, welcome everybody to the podcast. I'm Dr Jay Tita this is the Next Level Human Podcast and welcome to the show. And I have a brand new friend that I just recently met, actually in Vegas, we were at a business conference together. This is Lauren Fitzgerald MD, and we got to talking because we're both in the functional medicine space and she began to educate me on a really cool thing that she's been working on. Lauren, by the way, if you follow her over on her social media, she does a lot in anti-aging, a lot with functional medicine, and she is really educating me now in this new thing that is going on in the world of the GLP-1 agonist. You all will know it as Ozempic that's the most popular one. Sameglotide is the drug name and Lauren has been educating me on how she is using these compounds in unique ways.
Speaker 1:So, lauren, welcome, I'm very excited you're here and I know that my people are going to be excited to meet you, but why don't you give us a little bit of a background? You're an MD, I am. I'm an MD. We both do functional medicine, and I would love to hear how you got into this space to start.
Speaker 2:Yeah, I'm actually a recovering anesthesiologist. I used to be an anesthesiologist and I just recognized in the OR how many people were there and they didn't need to be there. And I went to medical school because I really wanted to help people get well and, as you know, our health care system is really a sick care system. So I left my practice and I have been doing functional medicine since 2020. I opened up my own practice I'm outside of Chicago, in St Charles, Illinois, and just been doing the functional medicine thing for a couple of years. And then the GLP-1 agonist came about and I had a friend who's a colleague and she was like Lauren, you really need to look into this class of drugs. Because when I first heard it I was like, oh boy, the next weight loss drug. Because I'd never prescribed a weight loss drug before because of the side effects in the long term, especially like the amphetamines, like the fentamine, right. So I had a friend that she's like, literally, think about how many people are insulin resistant. Like this is really helping a ton of people. So I had about five female patients that I've been working with in my functional medicine clinic who were doing all the things and still could not lose the weight. So I asked him I'm like, do you mind if I experiment with you? And? And let's, let's use some aglutide and see if that helps. And all five of them had incredible success. And that was the point. I was like, all right, I'm going to start using this in my patients Now. I've used it in my patients. I've had about 25 to 50 patients. That had been great success, and this is when I decided to use it myself. So I'm 44 right now, but when I was in 2022, September of 2022, when I was 42, I'd just gotten back from a trip to Bali, Indonesia, and on that flight I was looking at pictures and I was just like I don't like how I look and I'm five, five and a half, and I was ranging between about 155 to 160. And no one would have looked at me and said I was fat, but I was definitely a lot fluffier and I didn't feel comfortable in my skin. So that was the point that I was like I'm going to try and use this Now. I've been using it in a lot of my other patients and I had crazy good success by using low doses but making sure that they're doing all of what I call the non-negotiables. So that was when I actually did it, just as I prescribed to my patients.
Speaker 2:I have five non-negotiables and I was on it from September until April, so about seven, eight months, um, I lost 25 pounds. So and I have maintained my weight loss since April of 2023. By doing all of the non-negotiables. I didn't lose any muscle and I am a huge proponent of it because it's a massive power tool in the weight loss journey and a lot of people just feel stuck and it's a momentum mover, right. So I've used it myself and now I've treated over a thousand patients on my weight loss program using semaglutide or trisepatide.
Speaker 2:I have some patients that want to go to the trisepatide, but I meet with them every month. I make sure that they're doing the five non-negotiables and I let them know from day one. If they're not going to do it, I will fire them because, ultimately, their success is a reflection of me and if they're not going to do the non-negotiables, they're not going to have the success that I know that they can have. Do the non-negotiables, they're not going to have the success that I know that they can have. So here I am I'm 17% body fat at 44. That's the leanest that I've ever been in my entire life and I 100% thank the use of Smagliti during those seven, eight months that I was on it to get me to this place where I've never been healthier and I've never looked as good.
Speaker 1:So yeah, well, you know it's funny, right, like it's it's funny when I met you, I certainly would. It's it's nice knowing people's age.
Speaker 2:You know, I would not have pegged you in your forties for sure.
Speaker 1:I would have said maybe early forties, but probably mid thirties to late thirties which is really interesting.
Speaker 1:Yeah, well, you know it's interesting because I really do think, you know, there's this idea of, you know, sort of metabolic age and there's this idea that it does correlate with the way we physically look and we're just not used to seeing fit, lean bodies in the forties and the fifties. So it's, it's really interesting and I kind of want to, you know, start our conversation with probably, I guess, the elephant in the room right Like here. We are two people who obviously look at functional medicine. We obviously are both. You know, you're more trained in the traditional, conventional model and have moved more into the alternative model. I'm more trained in the alternative model and have moved more into the conventional model. So we've kind of moved.
Speaker 1:But both of us have a bias towards natural medicine. And so one of the things that comes up a lot with people when we start to talk about these new weight loss drugs, which in my mind, are a pretty profound paradigm shift in terms of results that we have never seen before in anything natural or pharmaceutical. But when we talk about this, let's just get this out of the way first what made you? Because I have my own opinion and I'll express it If you want me to go first? I certainly will, but what?
Speaker 2:made you kind of go, you know what?
Speaker 1:Yeah, am I going to go into this pharmaceutical world? Because certainly you were slightly moving out of that right and certainly I have. I'm not anti-pharmaceutical at all, but I have a bias, you know, towards natural things, and so here we are talking about, you know, a pharmaceutical, and many people are turned off just by the fact that it's a pharmaceutical. So I'm wondering your thoughts around that and you know sort of how your patients have received this and and why you're embracing it.
Speaker 2:Well, I've always told my patients from day one I take my Western medicine tools, my functional medicine tools, and try and get you to the optimized, healthiest version of you with minimal to no pharmaceuticals and minimal to supplements. I mean, I believe in supplements, but you and I both know in our world a lot of functional medicine providers are like here take these 30 supplements every day the rest of your life and that one is not cost efficient. And two, who's going to really do that? I'm super disciplined and I can't take 30 supplements a day. So my I've been straightforward from the day one, like I'm not afraid to use Western medicine tools and use, you know, pharmaceuticals. But again, I feel like the GLP-1 agonist.
Speaker 2:It's a peptide that the body naturally makes, or natural desiccated thyroid. Those are hormones that our body naturally makes right, and we live in such a toxic environment where we are hit with so many interconnect disruptors from the air, from the food we eat, from the stuff we put on our body, the clothes that we put on our body. Our hormones are not where they're supposed to be. So, even though someone like you and me, who have done all of the right things, there's still some lacking. So I was. I didn't think it was going to work for me, actually, because I was doing all the things. I ate so healthy. I was lifting heavy, I was doing all the things and it was the momentum mover that got my weight loss going and I've maintained it for over a year now.
Speaker 1:Yeah, yeah and I'll, and I'll give just for people listening to this, I'll give you my take too, and it'd just be nice because you know, lauren and I have just met, so we haven't had a whole lot of these conversations. We wanted to have this conversation of getting to know each other in front of all of you, and I think it's an important and fun discussion having to see two practitioners just kind of meet each other and hash this stuff out. But hash this stuff out. But one of the things for me, lauren and this is going to be shocking maybe for a lot of people to hear, but I'm fairly sure you're going to agree with this because, being in the medical field, I've been in the weight loss space pretty much since I've been 15 years old. That's the first time that I actually got paid for personal training and one of the things that I will say I know right, it's like it's been a long time.
Speaker 1:But one of the things I will say is the weight loss space is incredibly difficult. I get people who asked me all the time cause I'm kind of moving out of that space, going more into mindset, and you know things like that but they used to ask me like, hey, what do you do for a living? And I'm like, well, I'm in the weight loss space. And they'd be like, what's that like? And I'm like, well, if you want to fail most all of the time, then you have an idea of the world that I live in. And so, from my perspective, I have done all of this stuff.
Speaker 1:For what is it? You know, 30 plus years now where I have tried everything right and including bioidentical, hormone replacement therapy, trt and progesterone and estrogen and all of the things, and what I will say is that I have never seen anything be that effective. You know, at best I would be getting 30% results. For people, the compliance was atrocious, and even when they were compliant, you know, I would have to admit I don't know what's going on here, and a lot of this has to do because of the compensatory mechanisms of metabolism constrained metabolism through exercise, compensatory hunger and cravings, you know, when we cut down calories. It has been a real battle. And so, from my perspective and people all the time have simply just been getting fatter and fatter and fatter Diabetes uh, diabesity is on the rise, right.
Speaker 1:And so from my perspective. That's why, when people ask me, why are you embracing this Jade Cause? I go listen, people are in trouble. We are absolutely in trouble in terms of our health care and there has been no tool to address this, and I am far more worried about the risks of being obese and diabetic than I am about the risks of a bioidentical what I would consider a bioidentical pharmacological aid, which to me is the GLP-1 agonist. And so, from my perspective, that's how I come at this, and I don't know if you have anything you want to add to that.
Speaker 2:I totally agree to that and I love the fact we have this in common, because my first job was a fitness instructor at 16. So I've been in the fitness industry for a long time. Actually, I have a YouTube channel. I haven't used it in forever, but it was. I have like 320,000 subscribers because it was all dance fitness. So I've been in the space.
Speaker 2:I've tried all of the things too, and you're right being so. The years that I was an anesthesiologist in the operating room, I got to see what end of life looks like, or not even just end of life, but what life looks like if you don't take care of your body. And for me, that fear factor is the number one reason. I've always taken care of my body. But, you said it, the obesity puts you at so much more risk for so many other things.
Speaker 2:So and I think it's funny, because the people that are worried about taking this pharmaceutical that it's really not a pharmaceutical, it's really just a peptide that the body naturally makes and you're just not making enough of it those are the same people that have no problems putting the artificial crap in their body. And you know it's like let's, let's look at the big picture and ultimately, I've just seen this change too many people's lives Like I am such a huge proponent and I've had a lot of people tell me thank you for being open and honest about the use of it, because I would have never considered using it until I heard you use it and I know there's a lot of people that use it secretly and don't tell and all of a sudden they look, you know, a little bit leaner, but it's I. It is such a safe peptide when done correctly safe peptide when done correctly. I've had zero patients with the gastroparesis or the pancreatitis or any of the bad things, because I use such low doses with my patients, yeah, yeah.
Speaker 1:So let's get into that here in a minute, but just briefly allow me. What I'm going to do just briefly is walk everyone through sort of how these drugs came into existence, in a sense. And then what I want you to do, lauren, is just check me, make sure that you don't want to add anything or correct me if I'm wrong on anything.
Speaker 1:But basically the way to think about these. What Lauren is educating us on is the idea that these really are, could be considered bioidentical hormones, right, and so in a sense, they're not actually hormones, because hormone has a specific definition it's derived from cholesterol, et cetera. But when we use the term hormones, what we're saying is a signaling molecule, and so this is one of the incretins that is released by the small intestines GLP and GIP. These compounds are released by the small intestines, the L and K cells in the intestines, and they go around the body and communicate to the pancreas, to the brain, to other endocrine organs as part of the body's communication system and they shut off hunger and they help us be more sensitive to insulin and do a number of other things in the body. And the story goes a little bit like this that this, the first discoveries of these, to my understanding, were around gastric bypass surgeries in the early days, and actually, funnily enough, I was a tech at East Carolina University Medical School at the time, early on in the gastric bypass thing, and what they were doing is, in this sense, they were bypassing certain aspects of the duodenum, the upper intestine, that contained a lot of the L cells, that contained a lot of the GLP or the GIP the K cells, rather that had a lot of the L cells that contained a lot of the GLP, or the GIP, the K cells, rather, that had a lot of GIP.
Speaker 1:So you ended up getting a lot more GLP to GIP ratio because of these gastric bypass, and what they were finding is that it wasn't a mechanism per se of a smaller stomach per se that was in these calorie reductions, but some of these people were having their diabetes revert almost immediately after surgery, and so this sent these researchers down a path of trying to figure out what is going on here, and what happened was one of the mechanisms. Perhaps the chief mechanism was they adjusted the GLP to GIP ratio and started to see how powerful this was. Now fast forward 20 years and we now have GLP-1 drugs, which would be, you know, trulicity, viada, you know Ozempic Rebelsis, all of these Extenda, all of these sort of names that you have heard, and of course, the new one, terzepatide or Monjoro, which is a GLP and GIP together, and actually it looks like the research may be showing that that might be more effective for weight loss.
Speaker 1:I don't know if you've heard that, lauren, but I don't know if you want to add anything to this. But this, to me, is a really interesting science, and actually for a long time when I first started to learn about this over the last 20 years, I was trying to do natural things. Bitter compounds release GLP, vinegar releases GLP, berberine releases GLP there's lots of things that release GLP and protein. By the way, when you eat protein, fat and carbohydrates, you release GLP and GIP, and it looks like protein intake may be a little bit more GLP related to GIP, and so we were trying to manipulate these things in many ways, and we've known about this science for a while now those of us who are in the field but these natural agents weren't able to move the needle as much. Now we have these compounds, and so do you want to add anything else to that? Just so people can get a sense of the history of this and why we find ourselves here.
Speaker 2:Well, I'm super impressed by you, by the way. You were spot on with everything. But the main thing that I want the listener to know is that the safety profile these have been around for a very long time. Even though they're new to you hearing them, they've been around for a long, long time. So any worry of because ultimately, when I meet with a patient, I let them know my goal is to use this as a tool to get you to your goal body weight and then wean you off of it.
Speaker 2:There are a lot of people that can. Because they create those habits, they don't lose muscle and they all understand that their muscle is their, their, the key to making sure that they can possibly wean off of it. But then there's going to be some that won't be able to wean off of it, Right? So ultimately, your success on this drug has everything to do with how how you create the new habits, the non-negotiables, and understanding that this is a tool that potentially doesn't need to be a forever tool. But if it is a forever tool, it is safe.
Speaker 2:It has been around for 20 plus years and it might be just like for me I have to take thyroid and I've tried to wean myself off of it, doing all of the things, all the functional medicine tricks and trades and my thyroid just it goes to the crapper. So I will forever take natural desiccated thyroid to optimize my thyroid. I don't feel like I'm weak or I did anything wrong. It just is what it is and it's kind of like that it's. If you have to be on this long-term, it's. The safety profile of these are awesome, Especially if used in smaller doses, not the higher doses which I'm sure we're going to talk about if used in smaller doses, not the higher doses which I'm sure we're going to talk about.
Speaker 1:Yeah, and I do want to get into that, because this is what you were educating me on and I had not heard of this and you were like hey, jade, you know you were using these in what would be considered micro doses. Let's go through sort of the macro dose first and the risks and benefits with this Cause I know you've had great success even using it as it's traditionally prescribed. Let's go through how that's done typically and then let's go through this new thing that you've been educating me on in terms of the micro dose and the benefits of potentially doing it that way instead.
Speaker 2:Perfect. So what's being done wrong is that patients are just being prescribed microdose, starting dose month one, the next dose, dose two, and without having any communication with a patient, and they are going to these high doses. There's never any kind of check on muscle protein, step count, the knee, the non-exercise activity, thermogenesis, and these patients are literally the higher the dose goes, the more severe the appetite suppression is. So literally it's like medically induced anorexia and that is not sustainable. And so what happens is that, yeah, you're going to lose weight, and you're going to lose weight really fast. But guess what? If you lose 50 pounds, 25 pounds of those are probably going to be from muscle, and the more muscle you lose, the slower your resting metabolic rate is and the more likely that you're going to need this drug forever because you've lost your muscle. So when the high doses are happening, they're not eating, they're not drinking, so they feel terrible. Those are the ones that are having the terrible nausea, vomiting. Those are the ones that are getting the pancreatitis. Those are the ones that are getting the stomach paralysis, the gastroparesis, and it's all from providers that are just blindly prescribing this because there are a lot of people making a lot of money from this, but they don't. They're they're doing it for the wrong reason. They're not being interactive with these patients to show them how powerful this tool is, but not let it hurt them.
Speaker 2:So the the microdosing I've been. You know, of course microdosing has been coined by a few different people, but I've been using small micro doses literally since day one because I'm using my intuition. As an anesthesiologist, I would never up a dose on a patient that's under anesthesia if I knew they were a lightweight Right. I have quite a few patients that have, literally like I have. This one nurse out of Ohio lost over 60 pounds at 0.25 milligrams. That's the starting dose for most people, but she's been doing all of the non-negotiables and she's doing it, you know, and it'll be very easy to get off of it.
Speaker 1:It's 2.5 milligrams typically, right, or is it 0.25?
Speaker 2:so so it, so it depends.
Speaker 2:So semaglutide, semaglutide however, you pronounce it, I like to call it semaglutide. Semaglutide, starting dose is 0.25, but terzapatide, so brand name, mongero or zep bound starting dose is 2.5. Yeah, yeah, so it's just movement, the decimal point one, but for the most part, the average, you know the. If you're talking about semaglutide ozempic will go be, it's 0.1, but for the most part, the average, you know the. If you're talking about semaglutide ozempic, wagovi, it's 0.25. And then you go to 0.5, then you go to one, and then you go to 1.5 and it's without any any talking to the patient. And those are the patients that are that we see on the news or on social media, that have all the problems.
Speaker 1:Yeah, let's talk about. You know the typical ones there's dizziness, there's nausea, there's sometimes vomiting. You can get some of the pancreatitis. In rare cases you can get gastroparesis, the basically the stomach stops doing its peristalsis, so you get stomach. You know food sitting in the stomach. What are some of the? I know there was a scare about thyroid cancers and things like that, although I saw a recent study, a meta-analysis, that looked at that, saying that that is not actually shown to be the case, but that's out there as well in the world. What are the things that people should be aware of if they're doing this in the traditional way, and then let's talk about how you're doing it better doing it better?
Speaker 2:So great question. So first of all, there has never been one thyroid cancer in a human from these GLP-1 agonists. So let's be clear, it happened in rats and rats have their thyroid has way more receptors, so we can't compare ourselves to rats. So I have plenty of patients that have had a history of thyroid cancer and I'm not worried about them at all because there have been zero patients with thyroid cancer connected to the use of these GLP-1 agonists.
Speaker 2:Pancreatitis typically happens in the patients that lose weight very fast and from day one when I meet my patients I let them know the goal is one pound of weight loss per week and I know that sounds slow and I don't want you to compare yourself with Susie Q down the road, because Susie Q down the road did it the wrong way. She lost 30 pounds in the first 30 days and guess what? She's the one that's going to do the pancreatitis and have all of the complications right. So I always establish like I don't want fast weight loss. The slow weight loss is the weight loss that typically stays off right. So pancreatitis really is just seen in the patients that are just cranking up the dose and have really fast weight loss, now the gastroparesis. So gastroparesis is basically slowing down of the stomach moving the food. So you see this more times than not in the type two diabetic that is a known side effect from someone who has had high blood glucose for years, typically decades. They started off with insulin-resistant stage and then they went to pre-diabetic and then they went to type 2 diabetic, not controlling their sugars. One of the known side effects of a patient like this is gastroparesis slowed gastric emptying. So if you have a patient like that that already has those underlying risk factors, they have a higher likelihood of having gastroparesis. On the higher doses.
Speaker 2:Now I've had zero patients with gastroparesis and I also remind them. I give them their protein goal right and I tell them they have to eat three meals with the protein goal divided by three. So if their protein goal is 120 grams of protein cause that's their ideal body weight, I let them know you're going to have to eat three meals five hours apart because it takes about that long for your body to move the stomach or move the food from the stomach into the small intestines. And if you do intermittent fasting, which I think most of us have done intermittent fasting at some point or other. It's really hard to fit all of that protein in if your eating window is only six, maybe even eight hours. So there's no magic about the 10 hour eating window. But I just found that with a lot of my patients. If they eat breakfast let's say it's seven o'clock and then five hours later they eat their protein, their 40 grams of protein or however their goal is and then five hours later they eat their, their last portion of protein, typically they have enough room so they can get all their protein in and they don't have any of the issues.
Speaker 2:The heartburn is something very common. If you already have heartburn before you start using one of these incretins, it's going to be a higher likelihood. So you can do things like make sure that you have three hours between the time you go to bed and the time that you eat. Right. Stay away from foods that loosen that lower esophageal sphincter, basically the door at the bottom of the esophagus that keeps the food in the stomach there are certain things like coffee, chocolate, spicy food certain foods that basically loosen that and put you at higher likelihood of oh, totally Exactly, Exactly.
Speaker 1:So if you have a provider that's giving you and what do you think about using things like ginger, digestive enzymes, things like that? Have you been using any of that kind of stuff?
Speaker 2:I have been, and then a trick that I used to use when I was an anesthesiologist is smelling rubbing alcohol actually makes nausea go away really fast. I used to use it all the time with my pregnant anesthesia patients. Yeah that we're getting epidurals and it would get nausea real fast. It almost sounds like pickle juice or mustard for cramps, which works incredibly well too. It sounds super weird.
Speaker 1:A lot of tools like that the tips and tricks you'll get from an anesthesiologist are good. All right, Well so here's the thing so the typical dose, then the typical low dose if I'm reading you right the typical low dose of 0.25 is you know you're not worried about that, but you go lower, right? So tell me about the typical dose. So you would pretty much just keep them at that dose and not go up, and or you might go down a little bit.
Speaker 1:So let's cover this whole idea of reducing the dosage or not going up high in dosage.
Speaker 2:Right, right. So it will totally depend on the patient, because there are certain patients that I've seen common thread like, oh, she's going to be a cheat date, like it's not going to take much for her. So if I have that feeling, I will literally cut that initial dose in half and be like 0.125 milligrams. And, just for the audience to understand, the maximum dose of semaglutide is literally two and a half milligrams. So the starting dose of 0.25 milligrams is one 10th of the max dose, right? So we're talking tiny, tiny doses. A large majority of my patients, though I will start off at that 0.25 milligrams and for me, I use semaglutide for most of my patients and less. There's two scenarios because triseptide is more expensive. So if I have a patient that's like I don't care, I want the best, because you know, when you're comparing semaglutide to triseptide, it's kind of like iPhone 14 versus iPhone 15. This is great, but this is even greater, right? So I have some patients that are like I want the best, I'll pay the extra. But more times than not, I get success with 90, probably 9% of my patients with semaglutide and it's it's more cost efficient and it's just worked for a lot of people. So, that being said, a large majority of my patients I will start them off with a 0.25 milligrams. Unless I have a feeling like she's going to be a cheap date, I can start her off at even lower dose. Or a patient like I learned this when I was an anesthesiologist If a patient tells you that they're sensitive medicine, listen to them. So if they come and tell me they're like I, I you know I pass out with one dose of Benadryl, then I'll be like all right, she's a cheap date, I'm going to go really low on her. And the nice thing about using compounded versus the commercial is that I can tweak that, that micro dose with that patient and literally I will dose the patient based on what their weight loss is. So if I see them, I will always ask them how many pounds have you lost in the last four weeks? As long as they've lost four pounds, I will keep them at that dose right Now. If they haven't lost that one pound of weight per week and they're doing all of the non-negotiables, then I'll go up and, depending on the patient, I'll let them know like, okay, we can go up just a little bit, or we can go up a lot, or we can go somewhere in the middle and I decide with them and I've always let them know what I think would be best for them. But ultimately, if they're not doing the non-negotiables, and they haven't lost that four pounds, I'm not going to go up on the dose. And they haven't lost that four pounds, I'm not going to go up on the dose. So that incentivized them to get their act together and doing all the non-negotiables. And just so you know the non-negotiables for me.
Speaker 2:I told you about the protein. I told you about lifting. I make them lift heavy stuff at least three days a week. I make them have a step count. So whether it's an iWatch or Oura Ring or whatever, I always start off at 10,000. But my goal is to get everyone walking about 15,000 steps a day, because apparently our ancestors used to walk between 15,000 to 20,000 steps a day. So that's my goal, but not everyone can start there.
Speaker 2:The other non-negotiable is the water drinking. You have to be proactive and stay on top of your hydration. And then the last non-negotiable is just you have to measure the data. No one likes to get on the scale if they'd struggle with their weight. But when I was on my own journey, I started to see the daily weigh-in, just like my daily sleep score, with my Oura Ring. It's just data that helps me stay on track right, and it ebbs and flows, but you can't change what you don't measure. So weight a DEXA scan. We're actually about to get a DEXA scan here at Laura Mar Med and I love that too.
Speaker 1:If you guys are more savvy, you can see how, so those are my what.
Speaker 1:Lauren's doing, and Lauren correct me on this If this is not what you're doing. But to me, the big thing and she mentioned this, the big thing is you got to keep your muscle mass. The degree like the degree to which you lose muscle is the degree to which this is not healthy weight loss and also correlated with you gaining this weight back. And so the protein intake and it sounds like what you're doing is ideal body weight. Some people go as high as current body weight. I like ideal body weight as well, because it's just easy. So you're doing protein, ideal body weight, and you're also getting them to do weight training, which tells the body, hey, we need this mechanical, you know sort of structure, we need our muscle, we got to keep it on our body. So those two things, it sounds like, are really just about main tainting the muscle and that those two things by itself by the way, I think you know most people don't know this, but literally a lot of you if you just did that amount of protein which, by the way, is not easy, if you don't plan for it, a lot of it is going to result in you losing weight. That in itself is very hunger suppressing as well, but it's really interesting. You're given this sort of double sort of approach here. So I really love that so much, and I also agree with you on the scale thing.
Speaker 1:From my perspective, daily weighing is a great thing to do, as long as you can turn the mindset into. This is just data. So let me just repeat to you what I have heard. So for a lot of your patients, when they first start out, you start out at the lowest dose that is typically dispensed and that they could probably just get straight from their pharmacist. However, what you do is you use compounding pharmacies and you essentially reduce that dose down a little bit to reduce some of the side effects that may come along, but also to allow for better sustainable results in these individuals that you're seeing. There's no reason, for example, to get someone losing 10 pounds in a week when you know that's not going to be sustainable and instead you're doing it in a way that's reducing the weight slowly.
Speaker 1:And one thing I had I asked you this question offline, but I'll ask you here so everyone can hear One of the things that I know most of these people are going to get these medications in a pen, a delivery pen with a pre-loaded pen and so, in that particular case, what lauren is doing correct me if I'm wrong, lauren, but what you're doing is you're essentially saying, no, we're not going to use the pen. I'm going to call this in and they're actually using a probably an insulin needle, I assume, to inject sub-Q. Correct, yeah?
Speaker 2:Correct, correct. I always tell patients I'm like, look, it's the smallest needle they make. It's the same needle that we use to inject Botox here. Right, and on the initial appointment I will go over them. Okay, you're going to take the vial out of the box, you're going to pop the lid, you're going to clean off the top with alcohol, you're going to turn it upside down, you're going to put that syringe in and you're going to pull it back until you see X amount of red liquid, cause it's compounded with B12. Right, but I, man, I've had zero problems with we. As long as you get a good quality compounding pharmacy, that is tier one. So it basically hasn't been hit by. You know all of the, the agencies that make sure that they're doing what they're supposed to. So there's some great compounding pharmacies out there and, um, honestly, so I don't take any insurance, but my monthly cost is cheaper than a lot of people if they were to pay the pharmacy because their health insurance is not covering will go via a ZEP bound, right.
Speaker 1:So and one thing for all of you to know about the compounding pharmacies is that a lot of times you know drugs are not individualized. So a compounding pharmacist allows the practitioner oftentimes to do more individualized medicine, whereas you know off the shelf prescriptions they're sort of a one size fits all prescription. Nothing necessarily wrong with that and obviously Lauren knows more than that, more about that than me, because this has been her domain for a long time but the way I've always thought about it is I use compounding pharmacies to be a little bit more specific and individualized to that patient, and it sounds like that's what's happening here as well. But it also sounds like what you're doing is you're allowing. It sounds like if I'm reading between the lines, then it that you know and this is more for thinking about the pens that you would basically use that maybe for the first month at a low dose, at the lowest dose pen, and then you move them to, uh, moving to a compounding pharmacist. Is that typically how it works?
Speaker 2:Um at first, when. I first started doing it, yes, but then I realized it was just way easier to just start from day one with a compounding pharmacy. So 100. It's crazy how much they're charging just for the commercial brand name from the world if their health insurance doesn't cover it.
Speaker 1:Yeah, yeah, yeah.
Speaker 2:Correct, oh, it's more than that. It's more than that, yeah, unless they've changed. But the last time someone told me they were like yeah, I checked it, which puts it out of the reach for most individuals Crazy.
Speaker 1:All right, so let me just follow up with a couple other things, a couple things you said. So it looks like you do agree that terzepatide manjaro is better if people want to afford that. But it seems to me you're using mostly ozempic someglotide and you're doing it most all the time. Now it sounds like you're compounding it regardless. Basically it seems like Correct, and even when you're compounding it you're starting at that lowest dose.
Speaker 1:That they might get from a pharmacist, but then you're either titrating down or do you ever go up, and is that mainly just if someone's not getting the results? You might go up above 0.25 or 2.5? Correct?
Speaker 2:Yeah, for sure. I mean I do have some patients that I the highest that I go before I suggest switching to triseptide once they get to the two milligram dose. That's approaching the maximum dose. You know, two and a half milligrams is pretty much the highest that you can go with semaglutide, ozempic or govi. So if they're, if they are at about two milligrams and they're still, they're doing all of the things and they're not losing weight, that's when I'll talk about let's, let's switch over to two triseptide and see if that works. And so far, knock on wood, a hundred percent of patients have had success that we're not getting the kind of results based on their work, the non-negotiables that they were putting in, even at the higher doses. But that's very few of my patients. Most of my patients reach their goal at 0.5 milligrams or some one milligram, but one milligram isn't even half of the maximum dose.
Speaker 1:That's so good to know how you're doing that. And let's round this conversation off, One of the cool things about what you're doing, Lauren, is you've got an N in the thousands now, which is really cool, which is really neat, and just so all of you listening, this is a relatively new drug. Not a lot of doctors unless you've got a pretty busy, you know, clinic are probably at those levels, and so the fact that Lauren has seen you know upwards of a thousand clients, that's that's a lot of good data for her to see. So it just it lends some really good credibility for us and really good information for all of us who have not seen, like I have not. I have not prescribed this drug at all to anyone yet, so that's why I'm keen to to learn from you. So let's wrap it up with.
Speaker 1:The question is probably on everyone's mind now, if they're excited about this is like, okay, well, how does it stay? How you know, obviously you're doing a lot of things as we go along to make sure that the results are continuous and don't rebound, Cause this is going to be the big thing, Like how long does it last? And so what are you seeing? And let's let me just reiterate this for you, Cause I know you're going to say it right off the bat you got to do these, these non-negotiables that Lauren is talking about. This is a big piece of keeping it, and also a big piece of keeping it is what she's the way she's actually delivering this without this huge, you know amount of fast weight loss. But what are you seeing there and what are some other tips that you're, you know, essentially using? Obviously, we would prefer these people make the lifestyle shifts, and this can be highly motivating for them too.
Speaker 2:So I'm just curious, people make the lifestyle shifts and this can be highly motivating for them too. So I'm just curious, obviously. Well, at the beginning, at the initial console, I always let them know look, you're spending too much money to go halfway Like I want you to go balls to the wall on this. So, like I, I asked them to cut out alcohol. Alcohol is only going to slow down the weight loss process. And I let them know look, once we get to your goal weight and we wean you off of this. If you want to try and reintroduce it and see if you can maintain your weight loss with a little bit of alcohol, cool.
Speaker 2:But what happens is most people realize, like the juice isn't worth the squeeze, like I really like how I look and feel and I don't want to even take a risk of bringing that back with outside stuff like alcohol, right, obviously using this opportunity to change the food. If they haven't already realized, like I had one patient she didn't follow me online. Most of my patients find me online, so they I do a lot of teaching on my Dr Lauren Fitz Instagram and so most patients already know like what I'm going to say when we are at one-on-one. But this one woman, she was just a referral and she literally didn't know anything about healthy food, so can I still eat pizza and ice cream on this and I'm like, oh God, okay, yep, yep, this is going to take a little bit longer than normal.
Speaker 2:So so really, I always let patients know look you, whether you're on this for three months, six months, nine months a year, however long. You want to understand that while you're on this, you're learning new habits, you're unlearning the bad habits that got you to carry this extra weight and you're having a mindset change, right. And once we get you to your goal weight, then we start the weaning process, and I always they're always nervous when they get to that goal weight and the W word comes up. All right, you're ready to wean. So I always let them know we will go as slow as you want. The goal is to go slow and steady, wean them off of it.
Speaker 2:So I cut their dose in half. Sometimes I don't even do it in half, I do it in a fourth. We'll go slow down three to four weeks and then we cut it down in half until we get a really low dose. And then we're at the really low dose. They're maintaining their weight loss, they're getting on the scale on a regular basis. Then we start to increase the days in between the dosing, and so that's exactly how I did it. I didn't follow anyone's protocol, I just did what felt natural, and before I knew it, I was like, huh, I haven't had an injection in like a month and I've maintained my weight and I'm doing all of the things. And here I am over a year later.
Speaker 1:You know, from my perspective. Then I just have a few more questions for you. The major one is I know when people see this, they're going to want to work with you. So how is that possible? Do you do distance clients? Is it only people in Illinois?
Speaker 2:Can you prescribe this to people outside of that? How do they get in touch with you? How do they get involved with your clinic? Oh, thank you for asking that. So I do do telemedicine. The states that are not available are California, Minnesota, Hawaii and Nevada. So if you're not in those states, you can email my staff at info at Laura Marmet. So that's info at LARI. I love that so much.
Speaker 1:Yeah, my you know my script rights are only.
Speaker 2:And then they'll answer all your questions in.
Speaker 1:California. So but that's great that you have that's the benefit of being an MD, right? You have a much broader script. So for all of you, you know. So in case you're not familiar, lauren does telemedicine that. So in case you're not familiar, lauren does telemedicine. That means wherever you are, in whatever state you are, you can work with her clinic Other than the state she mentioned. She gets with you, she takes your case, her clinic will work with you and they can actually prescribe these for you. So I don't want you to feel like you have to be in Illinois to be able to work with her. You can be in some of these other states as well. Lauren, I so appreciate you.
Speaker 2:No, these other states as well. Lauren, I so appreciate you. No, although this time of year it's really pretty, I mean it's 75 degrees. Well, I was just there in April. I don't know where you're at.
Speaker 1:Were you at PLMI. So I spoke at PLMI in Chicago in April Jeff Bland's event and yeah, so I was wondering if you were there, but it was beautiful. It was beautiful in April and I'm sure it's beautiful now.
Speaker 2:Okay, yeah.
Speaker 1:But you know, we all get afraid. We all get afraid of Chicago in the winter.
Speaker 2:Lauren, I'm just saying oh, it's, summertime is the best here, rightfully so, rightfully so.
Speaker 1:I don't even know what a polar vortex is, but I want to be clear.
Speaker 2:I was questioning my life at that point.
Speaker 1:I I was questioning my life at that point. I so appreciate you.
Speaker 2:I mean, you know it's like that whole idea of doser.
Speaker 1:You're a smart man, I really appreciate you doing that. Tell them where they can find you online, because you're just doing so many cool things on Instagram.
Speaker 2:I've been learning a ton from you, but where can they find you online if they want to get more of you? Hey, thank you. So so I I'm on instagram, facebook and and youtube, um. Instagram is my most active platform. It's at d-r-l-a-u-r-e-n-f-i-t-z? Um. My. My youtube channel used to be club fits fitness and I'm actually changing it over. I'm going to call it the dr lauren or the dr fits show and I'm going to start doing interviews with just like-minded people so that we can get out education and whatnot. So I'm sure I'm going to be interviewing you for that as well. And then Facebook is the.
Speaker 1:Lauren Fitzgerald MD. Everybody, thank you so much.
Speaker 2:I'm so excited that we've connected.
Speaker 1:I've got a new friend and colleague to educate me and do me a favor, Lauren.
Speaker 2:Stay on the line, just so. I want to make sure all this uploads.
Speaker 1:But for all of you, thank you for hanging out and we will talk to you soon. Amen.