Episode 105 | Nov 7, 2024

The Truth About GLP-1s And Metabolic Health, With Dr. Tyna Moore

Could GLP-1s offer more than just weight loss support? On this week’s Health Coach Talk, Dr. Sandi welcomes Dr. Tyna Moore, an expert in regenerative medicine and metabolic health, to discuss how these medications could open doors to healing and resilience when used with lifestyle shifts. Dr. Tyna’s approach combines nearly 30 years in naturopathic and chiropractic care with an open-minded perspective on metabolic tools that empower individuals to reclaim control over their health.

“GLP-1 is a naturally occurring peptide in our bodies… It acts upon our insulin signaling in a very positive way. But more importantly, it’s regenerative, healing, and anti-inflammatory on our immune system, on our brains, on our heart, on our pancreas, on our muscles, on our bones, on our joints… It has multitudes of impacts on many tissue systems and organ systems in our body that we’re not paying attention to.”

Dr. Tyna Moore

In this episode, Dr. Tyna and Dr. Sandi unpack the nuanced benefits of GLP-1 peptide medications that have gained popularity in weight loss and diabetes management. Dr. Tyna explains how these medications can enhance metabolic pathways when used with strength training, high-protein diets, and other metabolic supports. Through practical examples, she illustrates how a balanced approach to lifestyle and medication can help clients achieve health goals more sustainably. This conversation sheds light on the regenerative potential of peptides, emphasizing that dosing should be approached with care to avoid common pitfalls.

For health coaches, the conversation reinforces the role of lifestyle changes in achieving metabolic health while complementing medical treatments. Dr. Tyna’s insights on the link between metabolic and immune health offer practical guidance for helping clients build resilient, healthier lives. Coaches can use these strategies to help clients feel in control of their wellness journey, whether they’re managing chronic conditions, weight goals, or simply aiming for a stronger, healthier lifestyle.

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Dr. Sandi: Welcome to “Health Coach Talk.” Well, by now, no doubt you have heard about medications such as semaglutides, Ozempic, Wegovy, and the others that are focusing on helping people lose weight, manage type 2 diabetes. But there’s so much more. And often it comes down to dosing. And that’s the conversation I’m having with Dr. Tyna Moore on “Health Coach Talk.” We do a deep dive into these medications and particularly how, as a coach, you can work with them.

So, let me tell you about the amazing Dr. Tyna Moore. She has nearly 30 years of experience immersed in the medical field. She’s an expert in holistic regenerative medicine and resilient metabolic health. She’s licensed as a naturopathic physician and a chiropractor, drawing on knowledge from both traditional and alternative fields of science and medicine to provide a comprehensive perspective to individuals thriving to enhance their health and well-being. She is well-known for her fierce and open-minded exploration of the peptide semaglutide, Ozempic, as a longevity tool for healing.

Dr. Tyna champions medical autonomy, individual accountability, and she’s on a mission to help as many people as possible experience the freedom and joy that health brings. As the host of the Dr. Tyna Show podcast, this is a top-ranking podcast in the health and wellness space. She’s an international speaker. She’s dedicated to empowering others to take care of their well-being, take control of their well-being, and heal their metabolic health, build strength and resilience.

Her cornerstone recommendations for every patient and listener, weightlifting and sunshine. Yay, I’m in favor of that. And additionally, she extends her expertise to support fellow doctors in cultivating their online practices, helping them transition away from an insurance-centric model to reclaim their time, financial stability, and freedom. She lives in Oregon with her husband and her daughter, and she’s a proud dog mama. So, I know you will enjoy my discussion with Dr. Tyna Moore. Welcome, Dr. Tyna.

Dr. Tyna: Thanks for having me. I’m excited to be here.

Dr. Sandi: I have been a long-time fan, a real admirer of yours. And I just love how you approach health care and particularly people who are so metabolically, as you say, busted. And I was wondering if you could just start by sharing just what got you involved in this particular area.

Dr. Tyna: Oh, gosh. It’s been a journey. I have to say, when I was coming out of undergrad, I was very sick. I was a very sick kid. I was a very sick teenager. I was very ill in college. I almost died from a virus. And then I ended up getting a post-viral syndrome. Right as I got out of college, I moved back home with my parents, and I was working in a real estate agency as their receptionist with a biology degree from one of the top 10 bio schools in the nation. And I was so frustrated. And I applied for a job as a receptionist at a naturopathic clinic here in the Portland area. And I got rejected, but the guy liked me and so he sent my resume over. He faxed it over to this other guy, this other awesome doctor. And his name was Dr. Rick Marinelli, and he hired me as his receptionist.

And he taught me early on… This is the mid-90s. He taught me about the benefits of strength training and how I probably don’t want to be such a cardio bunny anymore and let that go and start focusing on muscle. He taught me the importance of protein. He taught me how heavy carbohydrate meals will screw up your insulin and knock you out, make you tired, and not think straight. He taught me the utility of keeping your waist circumference in check because that’s a really good indicator of metabolic health overall. He taught me all about body weight set points, all about how insulin, sensitivity, and signaling ties into it. And that was really it.

So, I’ve always carried that torch with me through the medicine that I practice. He was a regenerative medicine specialist, and I ended up following in that and doing… The bulk of my practice was regenerative injection therapies, but conditions like osteoporosis, osteoarthritis, things that I saw frequently ailing people, those are really just diabetes of the bones, diabetes of the joints. It’s a metabolic dysfunction pattern is what ends you up in this soup of insulin and leptin. And all of these things are inside the joint, are wreaking havoc and causing inflammation and deterioration. So, that’s always been the premise of my message. That’s the drum I’ve been beating.

And way back when I started online and I had no followers, I was telling people to deadlift and eat steak. And it was not popular, and I really wasn’t getting any growth with that at all. Back then, the big influencers were telling people to go vegan and do yoga, which I have no problem with, but that’s really not what I’m after. And so all these years later, here we are, and the message is still not sexy. Do the work. That’s my message. The only way out is through, but that’s what my mentor taught me and that’s what I really… And then I became a chiropractor and a naturopathic doctor myself through years. And I was in practice for a decade before I closed my practice right before COVID. Thank God, because I live in Oregon and things went crazy here. And that’s really still, that’s the drum I beat is get your shit together and keep it together. And the onus of responsibility is really on the individual to put in the work every single day. I know it’s hard. I’ve been plagued with chronic illness, chronic autoimmune disease, chronic pain, severe chronic pain for decades, for more of my life than I’ve been alive, like over half my life. And I just know, I live it. And the only way to keep things in check is to keep them in check and keep tight tabs on them.

So, it’s unfortunate because when I started in practice in 2008, my colleagues would give me grief and say, “Dr. Tyna thinks everybody has metabolic dysfunction,” because I was testing and screening everybody for metabolic markers. And now here we are in 2024 and everybody has metabolic dysfunction for the most part. Eighteen data showed that almost 94% of U.S. adults have busted cardiometabolic health and here we are. So, it’s a thing that’s not going away, so I’ll keep beating my drum.

Dr. Sandi: Yeah, I wish that I had heard that drum beat in the ’90s when you started because I was one of those people. I was vegan. I was even a crazy raw vegan for a time. And I was also yoga and dance classes, but weightlifting, I don’t know, but never anything serious. And I just wish that I had discovered that early because now I’m trying to play catch up and it’s pretty hard to gain muscle at my age, 74. I’m slowly doing it, but I see my friends, my contemporaries, and they’re just all metabolically busted. And I have to work so, so hard in terms of high protein and, you know, wear my CGM all the time. But it is an uphill battle.

So, thank you for your work. And there are just… We hear so much now about metabolism and having… Can you just explain? Because we have coaches and their role is to put it in really simple terms so that people can get it. And then they can say, “Yeah, I’m ready to change.” They have that aha moment like, “Okay, yeah, I’m ready to start. Help me through it.” But how can they explain? Because they may not understand when we say only 6%, 7% of adult Americans are metabolically healthy. What do we mean by that?

Dr. Tyna: Sure. So, well, first off, I will say as my mentor was dying, he died of cancer, sadly. And as he was dying, he told me to never forget docere. And docere means doctor as teacher. And I tattooed it on my wrist. So, I love trying to put things in the most simplistic terms, because he also always taught me that you see one, do one, teach one. So, if I can explain it simple enough for my followers and for listeners of your show to understand, then they can turn around and spread that message, then we all win.

So, basically, the way I see it is, cellularly, our cells run on glucose. We have to have a glucose sink. So, we need ourselves to be able to uptake glucose readily and utilize it for fuel. Now, there’s the whole conversation of ketosis and all that. I’m not talking about that. I’m just talking in general physiology. When we consume carbohydrates, we have to be able to have glucose sinks working in our bodies. One way that we hear a lot about is insulin, right? We’ve got this concept of insulin receptors. They bind the insulin. What happens at that point is there’s a little receptor called a GLUT4 receptor. Just remember GLUT4. It has to translocate. It has to leave the cell and go to the membrane and open, and that lets all the glucose in. So, that’s generally how people understand this to work, right?

And what happens once the glucose comes in, long story short, our mitochondria turn it into ATP, which is energy, right? So, our mitochondria are the powerhouses of our cell. Everybody’s been hyper-focused on insulin and insulin resistance. What happens with insulin resistance is, folks, our mechanisms are breaking down in the body. Usually, the mitochondria start struggling. And we end up in the situation where the cells are getting flooded with glucose. The pancreas kicks in and starts pumping out insulin at excess. And now the cells are swimming in this soup of insulin and glucose, and they’re like, “Yo, we’ve had enough. We are full. We don’t need anymore.” So, they start cleaving off insulin receptors. This is what happens when you flood the body with any hormone or peptide. It starts pulling back receptors.

So, it starts pulling back its insulin receptors. And now insulin can’t bind the receptor. The GLUT4 receptor does not get sent off to the membrane to open and let the glucose in the cell. So, now the cells are starving. They’re cleaving off their receptors, and it’s a whole big pickle. This is really how we’ve understood all of this for the longest time. And something I talk about at length online is insulin resistance and insulin sensitivity, but that’s only a piece of the puzzle. This GLUT4 receptor can translocate to the membrane and open and let glucose in and be a glucose sink in a multitude of other ways. A big one is strength training, and actually the literal act of contracting the muscle will independently cause the GLUT4 receptor to translocate to the membrane.

Other ways of getting it up there are to activate different pathways like the AMPK or the CERT1 pathway. These go down and they activate another pathway that essentially causes these insulin-independent… So, they’re not… It has nothing to do with insulin. These are insulin-independent pathways that allow for that GLUT4 receptor to come to the membrane, let in the glucose, and act as a glucose disposal system or a sink. And the way we activate those pathways is through exercise. So, separate from the contraction of muscle, just the act of exercise, fasting or caloric restriction, GLP-1s do it too. And there’s other ways, but the power of exercise in the conversation of dealing with this insulin resistance cannot be ignored because everybody wants to say, “Oh, I’ll get to the exercise part later. First, I’m going to go super low carb.” And that’s how we’ve been handling it for decades, right? Just go super low carb. A super low carb diet, especially one that’s very high in arachidonic acid like a carnivore diet, for instance, can actually lead to…through different peptide signaling hormones, can lead to insulin resistance as well, or potentiate it.

So, that conversation of just focusing on insulin and insulin resistance is really short-sighted, and we have other tools available to us like intermittent fasting and exercise and muscle contractions that serve us very well. Also, muscle itself is one of our most mitochondrial-dense tissues. Our muscles and our liver are what take up our glucose and store it for later use. Like we got to run away from a tiger, we got to have some storage on board. The less muscle we have, the less of a storage facility we have. It all ends up in the liver, and it causes fatty marbling of the liver. It causes fatty marbling of the muscle. That pathologic muscle and liver potentiates a vicious cycle of further insulin resistance and further metabolic dysfunction. And the whole thing goes to hell in a handbasket. So, long story short, we have to optimize all the tools available to us to create the best glucose sinks and glucose disposal system so that the rest of our cells and our mitochondria function optimally.

Dr. Sandi: When we talk about exercise, what we’re really talking about, because I see this all the time, I go to a local gym and I post reels about like, here’s the weight room and there’s me and all of these guys, these high school kids or older men, but the rare woman. And if she’s in there, I saw somebody on the hip abductor the other day, and she literally had 10 pounds on it. And she was on her phone and her legs are just opening and closing, doing nothing, or they are lifting the pink weights in these group classes or Pilates with weights and not really serious or even with personal trainers. I’ve had personal trainers and I’ve had to let them go because they just wanted to do three sets of… And they kept starting me on such low weight. And then when I didn’t hit the session, I’d go back and I would do the same thing with heavy weights, four sets. That’s the only way I was able to build muscle. So, it’s so hard and they’re afraid they’re going to hurt something. And they’re in the cardio room. They’re on the elliptical or they’re going to Orangetheory. And yeah, I know we want to get into the medications and Ozempic, but can you just talk about…?

Dr. Tyna: No, I love this talk. I’ll talk about strength training all day.

Dr. Sandi: Yeah. But how do you help people where they’ll say, “It’s just too late. It’s too late for me. I’m too old. I can’t build muscle”?

Dr. Tyna: Oh, that breaks my heart. It’s never too late for anything. So, the way that I describe it to patients is we do have good data showing that you can still build good, healthy muscle in the older years. But the part that’s missed, we need the muscle itself and we can focus on the muscle. The strength of that muscle is super important in terms of longevity and just the ability to be harder to kill and withstand illness and death. So, strength is really important. Grip strength is really important. These are parameters that, whether you have small muscle or big muscle, my husband’s a farmer and he’s really thin. He’s not buff. He doesn’t look buff. He’s got great, lean, strong muscles. He’s just built that way, but he’s farm strong and he is so strong. So, that’s an important factor as well.

And so we’re always building strength if we’re out there doing the work and no matter what age we are. The muscle itself does matter. But as I just described, the act of building the muscle is like, who knows what percentage important as far as getting our metabolic health in order? Because what happens with that metabolic dysfunction is the more years we have under our belt, there’s this process called inflammaging. And we will by no fault of our own, no matter how hard we work, become more insulin resistant, more metabolically compromised and more inflamed as we age. It’s just the process of aging. And so we have to literally fight it off. And ideally, we would be training for menopause. Ideally, everybody would start, well, much younger, but I really started hitting it in my late 30s, early 40s, because I was like… My mom went through menopause and that was not pretty. And I looked at my whole family after whatever that midlife transition was, and it was a train wreck. And I was like, “No, thank you.” I come from a bunch of little round people with heart disease and diabetes. And I was like, “No, thank you. I don’t want to go down that path.” But more importantly, the actual act of exercising, the actual act of squeezing those muscles and contracting those muscles on a regular basis are contributing so profoundly to our overall metabolic health, which is intimately impacting and dictating our inflammation and our immune system.

So, if our metabolic health is in check, our immune system is a little bit more reliable or a lot more reliable. So, when illnesses come our way, we’re not sitting there like a sitting duck going, “Well, I guess whatever’s going to happen is going to happen.” It’s like, no, I trained for this. So, when upper respiratory viruses come knocking or when whatever’s going around is going around, you’re like, “I think I’m going to be okay,” because we have the data. The folks that were exercising prior to contracting the virus that was recently making its way, significant reductions in even contracting the virus, let alone impacts down the line of, were they going to end up in a hospital? Were they going to end up in ICU? Were they going to end up dead? Like marked protection from just exercise. And this wasn’t even… This was studies from all over the world. This wasn’t even like any particular kind of exercise. It didn’t matter. People were exercising like two hours. I think it was like two hours several times a week, roughly your 150 minutes of exercise they talk about. That could have been walking. Active people do better with everything.

And frailty is truly the kiss of death. And I think frailty… Sarcopenia is the term where that inflammaging or inflammation process, that metabolic dysfunction starts to literally create a pathology in our muscles and we start to waste. It self-potentiates itself. Once that fatty infiltrates in there, now that inflammation is brewing even harder and now the whole thing starts breaking down quite rapidly. And that sarcopenic state, that frailty state is the kiss of death. You do not want to go into any illness, stress, trauma, nothing. You want nothing in your life bad to come your way when you’re in a frail state because it can really take you out quickly. And those who had frailty going into the virus did very poorly. And this is why we see our elderly population decline so quickly when any kind of virus makes its way through. They sadly call it dry kindling in the medical world. The older folks who are just sitting there waiting for a virus to take them out because they’re frail and they’re malnourished, it’s a real problem. And as we age, we lose bones. So, our teeth start falling out and we have atrophy everywhere, including our digestive tract. So, we’re not absorbing our nutrients as well. It takes more protein to actually induce muscle protein synthesis than it did when we were in our 30s. And I’m explaining this as if I’m talking about the geriatric population, but this is happening in your 30s, in your 40s, in your 50s. And if you don’t right the ship by say 45 to 50, early 50s, it’s very difficult to get that metabolic dysfunction under control.

We just had a study come out, maybe you saw it. It was this week showing that there’s not this precipitous aging that happens. It’s like a big whomp around 44 and a big whomp around 60. There’s like this rapid aging process. And I had that happen to me. I wasn’t 44. I was 47 and I felt it. There was a rapid aging process that happened. I had bone loss in my face. My facial structure changed. It was marked. If I wasn’t paying such close attention, I wouldn’t have noticed it, but I was like, “What is happening? Something is happening.” So, I think it’s so important that people become educated. Everybody, not just health coaches, not just doctors. Doctors don’t know most of this stuff, you guys. So, the health coaches I found to be way more up on this than the doctors. The doctors have no appreciation for it for the most part.

And having a basic understanding of this and teaching your family to appreciate it and to really understand what they’re dealing with is like that’s how we stay alive and that’s how we stay well. So, we can build muscle later. It’s harder, and we don’t have all the hormones on board, and we don’t have as marked muscle protein synthesis as we did when we were young. But the way I say to my patients is like, what are you going to do otherwise? You got to do something. So, just because you’re not going to move the dial like you did when you were 30, who cares? We still are going to move the dial. It’s still going to have an impact. Losing five pounds when you’re 100 pounds overweight seems like nothing, but you’re still going to have improvement in inflammatory markers. And you’re still going to have these cellular processes going in the right direction as you commence on that journey. So, we don’t give up. We don’t quit. We just reroute, right? It’s like Dory from “Finding Nemo.” Remember, she’s like, “Just keep swimming. Just keep swimming.” That’s what I always think.

Dr. Sandi: That’s right. I loved that.

Dr. Tyna: I’m like just keep swimming.

Dr. Sandi: Just keep swimming. Persevere. Keep moving. And, yeah, so I, in November, broke my fifth metatarsal doing something really stupid, getting down to the floor on a bare floor, which I always do on a mat. So, anyways, I was in a boot for at least eight weeks and like, “Oh, no, I’m going to waste away. I’m going to lose all my muscle.” And then I said, “Well, I can do upper body,” and, like, crazy every single day. I was pushing, pulling, doing pull-ups. I was doing anything possible with a boot. I had Googled, “What can I do with a boot? What are different exercises?” I was doing rowing. I devised my own system, but it worked and I didn’t lose… I had to work to get back. I lost some balance and that came back, but it is that you cannot give up. I do handstands every single day.

Dr. Tyna: Oh, my gosh. You’re like my goals.

Dr. Sandi: I’m going to be doing it through 100. I’ve decided I’m never going to give up doing handstands, push-ups every day. You just have to keep working when you’re in your ’70s, because you lose it so fast. But speaking about losing it, so many people that I know are saying, “I want to take Ozempic, Wegovy.” Can you talk about… Because you have a very unique perspective on this and there are a lot of myths, there are a lot of misconceptions about it. So, can you start to break this down? Like, what are we talking about? Is it a peptide? And can you talk about the GLP-1, GIPs to give us a, kind of, a basic education and then the myths that are out there about this and how they should be used?

Dr. Tyna: Sure. So, I got to thinking about this a year ago very differently than the way it was being promoted at the time. And I was seeing a lot of propagandized fear going all over. And I was like, “This smells off.” So, I dug into the research because I’m a super nerd like that. And what I found is very interesting. Number one, it’s a peptide. So, peptide is just a string of amino acids, and a string of peptides makes up a protein. So, our bodies are made of peptides. Our bodies are made of proteins. Our bodies are made of peptides. Subsequently, our bodies are made of amino acids. And it just got co-opted by Big Pharma because of its delivery system being injectable. Some peptides are not the right size to take orally, so they end up in the pharmaceutical route.

GLP-1 is a naturally occurring peptide in our bodies. It’s endogenously produced by our cells in our gut called our L cells and it’s also produced in our brain. And there are receptors throughout our body, some more densely populated than others for GLP-1. So, the way that GLP-1 was originally studied for, it was for its neuroregenerative effects. It just happened to be tested and used successfully for type 2 diabetes. So, that was just serendipitous that it got figured out with type 2 diabetes first. And then use around it was like, “Oh, hey, these people were using it for diabetes. They’re losing weight.” So, then the weight loss conversation started. But these peptides have been around in the pharmaceutical world for 20 years and used very safely. It was not until the weight loss conversation came up that people started losing their minds all over the place and having very strong opinions, which that’s a whole interesting conversation by itself.

But these peptides act upon our insulin signaling in a very positive way. But more importantly, they’re regenerative healing and anti-inflammatory on our immune system, on our brains, on our heart, on our pancreas, on our muscles, on our bones, on our joints. They are having positive impacts on our ovaries, on our testes, and leading to improvements in fertility just across the board. Pretty miraculous data that I dug up. And I’ve been neck-deep in this for a year. Mountains of data. And what I found is not what the mainstream media is telling us. And it got me to thinking very early, well, if this is a peptide, then I would use it like I use other peptides. Clinically, my background’s in regenerative injection therapy, so I’m familiar with peptides and regenerative medicine. We use small doses, and we titrate up incrementally to get the optimal dose for the individual sitting in front of us. We don’t go on this super crazy high-dosage journey.

So, in the standard allopathic community, they come in pens that are pre-filled, and they have a pre-determined dose. We can’t dial it down. It is what it is for the most part. So, people are being started, I believe in many cases, on too high of a dose to start with. And then they’re ramped up very quickly over the course of about 16 weeks. That dose is basically doubled every month. So, whether we’re using a peptide like GLP-1 only, which would be semaglutide, this is Wegovi and Ozempic are the other brand names for it. Tirzepatide is a GLP-1 agonist along with having a GIP agonist in there, which plays on our glucagon a bit. And that one is dosed differently but also ramped up very quickly and the dose basically doubled.

So, two different peptides. When I talk about GLP-1 agonists, I’m talking about both of them. There’s new ones coming out on the list in the big pharma world. And I think that people are being dosed way too high way too fast and getting put up on these high doses that are not serving them at all. It is leading to muscle loss. The peptide itself does not induce muscle loss. The peptide basically at a high dose is going to crush someone’s appetite and that person’s going to stop eating. And that severely calorically restricted state is going to lead to the percentage of lean mass loss that we’re seeing in the studies. And muscle mass is but one part of our lean mass. So, when they talk about that loss percentage, they’re talking about lean mass loss overall. This is on par with any severely calorically restricted diet, and it’s also on par with bariatric surgery.

So, I don’t think any of that’s necessary. I think that is a mismanagement and a poor dosing strategy for a lot of folks and potentially not great compliance on the patient’s part because maybe the doctor’s not educating or informing, maybe the doctor’s not monitoring but also the patients maybe are not choosing nutritionally dense foods and they’re choosing to eat less potato chips or less of the maybe standard American diet that they’re already eating. And so there’s a lot going on over there, but it’s not the peptide’s fault. The peptide is just being misused there. And I think done in really tiny doses or much smaller doses, then we’re seeing very different impacts. And I’m using it over here in folks that are like yourself, already very metabolically optimized. And then we’re able to apply what I’m calling a microdose, which is a fraction, like a mere fraction of the standard starting dose. A lot of doctors right now, this term’s catching life and it’s going around the internet. And a lot of doctors are saying, “Oh, I’m microdosing.” They’re not. Nine times out of 10, they’re simply giving the standard starting dose and maybe tearing up to the next dose. They’re doubling the dose after four weeks. That is not a microdose. I don’t have hardly anybody even at the standard starting dose. I’m talking to metabolically optimized people who maybe want to use it for neurocognitive benefits or for a whole host. I’ve got patients on it with Crohn’s disease, PCOS, acne, depression, high blood pressure. The cardiovascular impacts are phenomenal. It remyelinates the nerves in MS. The studies around neurobenefits are phenomenal.

And so I’m using it differently and we only keep the dose really low if patients are doing all the things. So, they have to be doing all the things as we call it, the strength training, the eating enough protein, the getting sunlight, the going to bed on time, optimizing their sleep, all the things that we talk about in the metabolic world. Then they can keep that dose really low. And we’re using other peptides and hormones usually. If somebody’s very metabolically compromised, meaning dosing may apply, the starting standard doses, the approach has been to go very, very slow and low. It’s always about slow and low.

And so I’ve got one patient, this only patient I’m using it truly for weight loss. And he’s a very obese, older, in his 80s, diabetic. And it’s taken us almost a year to get him to just half of what their top dose is. And he’s doing very well. We went very slow and low with him and not having any appreciable mass loss, or I should say lean mass loss, no appetite suppression. Just what I say with folks is we want to dose up to appetite control, not appetite suppression. And we want to keep the dose low enough that we don’t have any of these side effects. And that’s different for everyone. So, it’s a very individualized approach. But to get to the side effects, you want me to hit those real quick?

Dr. Sandi: Sure. I’d love to hear that.

Dr. Tyna: Yeah. I want to dispel some myths because gastroparesis, which is the stomach paralysis that they’re saying is permanent. First of all, it’s not permanent. Gastroparesis, pancreatitis, thyroid, the potential for thyroid cancer, which I’ll hit on, and gallbladder issues. These are all actually very prevalent in the type 2 diabetics, in the folks dealing with obesity. These are very common in that community. Gastroparesis is happening in the type 2 diabetic more often than we have any appreciation for. The hyperglycemia, the excess blood sugar is leading to destruction and damage to the vagus nerve that leads to the stomach. And so they’re sitting on the edge of these conditions already, and then they’re getting dosed too high, too fast, and thrust over the edge. And so they’re ending up… You’re hearing these terrible things.

Now in reality, the percentages of this happening are much lower than the media is leading us to believe. There’s definitely a propagandized push against these peptides. Maybe it’s because I’ve found studies showing efficacy and really interesting protective measures with COVID. There’s even data coming out right now showing some potential protective impacts on cancer. So, it makes me wonder maybe they don’t want everybody… Plus the money that is made off of type 2 diabetes in this country is a very lucrative business model for many industries. There’s a lot of money to be made off of folks that are sitting in that state.

So, anyway, the thyroid cancer, the black box warning is about rats. It was a study done on rats, and these rats were given really high doses. And they tend to have… If you’ve ever had pet rats, they do tend towards this really weird medullary thyroid cancer, which is not very common in humans but is very common in rats and rodents. And even the control group got spontaneous medullary thyroid cancer during that study. So, they don’t tell you that. And in the recent months, they’ve looked at all the data over the years. Like I said, these peptides have been around for decades. It’s just not adding up. The thyroid cancer risk really is not entirely adding up and it’s been put to bed in the medical community.

However, I would say if you have a history of thyroid cancer, you have a family member with a history of thyroid cancer, definitely be cautious and talk to your practitioner. Don’t go to a medi-spa, go to a doctor who knows what they’re doing and make sure you have an educated conversation about it. The risk of biliary disease is real, but again, folks who have sluggish gallbladders tend to be on that heavier set type 2 diabetic group. So, all I’m saying is the people most taking this peptide are also the people most inclined to these conditions, right? That’s the point I’m trying to get across. So, if we’ve got a population that’s already at high risk for a lot of these things and then they’re getting slammed on too high doses of this peptide, we have a problem.

If you stop eating abruptly and you go into a very caloric state, your bile gets sludgy. And so your already sludgy gallbladder gets really sludgy and you have the risk of throwing a stone. This is why we don’t put people who have biliary conditions on hardcore fast because we don’t want them throwing a gallstone. And that stone gets thrown into the pancreas and it causes pancreatitis. So, there’s a risk there. The other big risk factor for pancreatitis is fatty pancreas. We get fatty pancreas when we get fatty liver and we get that when we have metabolic dysfunction. So, the population most at risk for these conditions are the ones most often on the medications, right, or on the peptide. So, I’m not as concerned, but if you have a history of gallbladder or biliary issues, obviously again, talk with your practitioner, go very low and slow, be very cognizant of what you’re doing, make good choices with your food intake and mindful that this is a potential risk.

So, the big scary side effects that we keep hearing about, again, dosing and management issue. It’s not necessary to have these things happen. And if you look at… The SELECT trial was wrapped up at the end of 2023. It was the big cardiovascular study. And, yes, it was sponsored by Novo Nordisk, so people want to poo-poo it. However, what they found, they looked at middle-aged overweight folks who did not have type 2 diabetes. And this group, I would argue is probably on their way to type 2 diabetes because middle age fat really becomes inflammatory around middle age. So, if you’ve had excess adipose on you for a long time, eventually it will become pro-inflammatory and you will walk into metabolic dysfunction. We have the data to support that.

So, this group had a profound like 20% reduction in severe cardiovascular outcomes, which I think is so cool. And so then the next argument was, well, it was sponsored by Novo Nordisk and doesn’t cardiovascular risk go down when you lose weight. And I would argue, yes, of course, that’s awesome. And you improve your metabolic health. Yes, of course, that’s awesome. But then just recently, they revisited that data and they did some follow-up. And they found that independent of weight loss, these folks were still having really profound cardiovascular protection. And all of these other benefits from tip to toe that I mentioned in the body seem to be independent of weight loss and type 2 diabetes.

My argument is that this peptide just happened to serendipitously be found to be useful for type 2 diabetes and obesity. I don’t think that’s its main job in the body. I think it has multitudes of impacts on many tissue systems and organ systems in our body that we’re not paying attention to. And we might be able to support these systems with much, much lower dosing and utilize this peptide as a way to potentially, I argue and what I’m seeing with patients and what I’m hearing from my followers is they’re able to get off a whole host of other pharmaceuticals when they start taking the GLP-1s and it starts really working and healing up their tissues. And for the folks who want to say, oh, it’s just a Band-Aid, that’s nonsense. It’s healing. It’s healing the insulin signaling pathways. It’s promoting those other pathways I mentioned to get that GLUT4 translocation. So, the longer someone’s on it, the more potential for healing that they have. But if you crank somebody up really high, we don’t know, but I speculate we would still get that resistance that I spoke up with insulin resistance.

If you’re on anything, any hormone, any peptide for too long at too high a dose, you run the risk of it not working anymore and you have to keep cranking up the dose. I’m seeing that with this peptide. Even at the low doses, when people mess around with their diet or they’re not exercising or they’re drinking too much or they’re not getting their sleep, they’re needing a higher dose to get the same impact we were having on a lower dose. So, this is where I argue we have to do all the things and we have to stack our therapies, including exercise and strength training, along with our nutritional interventions. These are non-negotiable for the person utilizing GLP-1s. And I think this is where health coaches come in because you guys can support them on this journey and make sure they’re doing all the other things, maybe with the help of a strength and conditioning coach. Who knows? But like getting them dialed in so that… Because the other part of this is it induces neuroplasticity, which is this idea that we can rewire our brain. And so when people say, “Oh, this is just a cop-out, it’s an excuse,” no, it’s not. It also plays on our dopamine pathways. And when people take these peptides, it puts the onus of control back in the driver’s seat. And many people report, “Oh, my gosh, I feel normal. I have normal appetite. I have normal control over my vices. I don’t want to drink as much. I don’t want to smoke as much.” My friend the other day said, “I’m not doom scrolling on Instagram anymore.” People get control back. And so if you can give someone control whilst you’re taking them on this journey of lifestyle changes, we know how hard it is to get people to… It’s a fricking mountain. I need you to do all these things, right? It’s daunting, right? And this is where health coaches can help on that journey. But if we could give somebody some control, so they felt like that was even possible versus trying to take the person who’s just so downtrodden and feeling so awful, and maybe they do have a lot of weight to lose and they’re like, “I can’t even chop my own vegetables. I’m so exhausted,” and you’re like, “I need you to work out three times a week and I need you to…” It’s too much. I know…

Dr. Sandi: Exactly.

Dr. Tyna: I used to basically be like a fancy health coach in my practice, right? That’s most of the work we did. And so if we can give them some control back and have them feel like they actually can do the changes necessary, it opens this window. And as they’re making those changes, this neuroplasticity is happening in the brain due to the peptide being there. It causes new pathways to be wired. And so in my head, I’m thinking this is an opportunity to help clients and patients rewire healthy habits that maybe they never had before. It’s literally a window of opportunity to wire in these lifestyle changes that are going to carry them forever. So, even if they use it for a short time, we got to take full advantage of that window of opportunity and not just, “Here’s your pen. Good luck. Go dose yourself into oblivion,” and none of us are around to help support the journey because it’s the journey I think that is more important than the destination in this case.

Dr. Sandi: So well said. This is inspirational and this is spot on. And so it is not one size fits all. It’s not megadosing, but it is working with a practitioner who understands what you’re saying, who gets it, and then having a coach who’s going to help them with the lifestyle because it’s not either/or. And so when you have that combination, that’s a winning combination. It reminds me in many ways. I was of the generation that would never take bioidentical hormones because of the women’s health study. And it was like, it’s awful. It’ll give you cancer. And now we’re finding, well, wait a minute. So, that’s a whole other conversation, but it is very similar where we want to look at intelligent use. It’s not all medicine bad, all lifestyle change good, but it’s a combination and what works for the individual.

Dr. Tyna, I feel like we could go on and on. I want to have you back. This is incredible.

Dr. Tyna: Yeah, I’ll come back.

Dr. Sandi: And we are just getting started, but where can people find you to learn more?

Dr. Tyna: I have a four-part video series where I dive into this in a bit more detail. You guys can have that. It’s free. It’s on my website, or you can go to drtyna.com/ozempicuncovered, and that’ll give you a deeper dive into some of what I just brought up. And then I actually have a course from there. It’s specifically for health practitioners, but I allow the public in. So, if you’re a health coach looking to support your clients, it’s a great course. And then I’m on Instagram @drtyna. That’s my website, drtyna.com. And I’m on YouTube as well. So, you can find me there. Oh, my podcast. I have a podcast. I got to get you on my podcast.

Dr. Sandi: Yes, it’s a great podcast.

Dr. Tyna: You got to get on there. We got to talk about strength training in your 70s. You’ve inspired me.

Dr. Sandi: Yeah, I would love to.

Dr. Tyna: All right.

Dr. Sandi: All right. Well, thank you so, so much.

Dr. Tyna: Yeah. Thanks for having me.