Ozempic 101: Microdosing, PCOS, Fertility & Building Metabolic Health w/ Dr. Tyna Moore
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The reason I came up with this concept of utilizing these GLP-1s outside of weight loss and diabetes was because we had all this data showing that they had these impacts on different organ systems of the body. Why not? This is the Pursuit of Wellness podcast, and I'm your host, Mari Llewellyn.

What is up, guys? On today's episode of The Pursuit of Wellness, we have Dr. Tina Moore. She is a naturopathic and chiropractic physician with expertise in regenerative medicine. She is joining us today to provide clarity on GLP-1 medications, aka Ozempic and variations of Ozempic. I'm going to start with you, Tina.

I have touched on this in a few episodes with other experts, but finally we have an expert who really is honing in and focusing on GLP-1 and giving us the information that we want to know. She has a background in metabolic health and chronic pain management. She explains how GLP-1 can benefit individuals with weight loss goals,

PCOS, and insulin resistance. She shares valuable advice on individualizing doses, understanding how these medications interact with insulin and muscle mass, how to approach conversations with your doctors about dosage. We also cover the risks associated with Ozempic.

especially in those dealing with metabolic dysfunction and discuss how these drugs impact areas like fertility, chronic pain, and even addiction. What I found really interesting about this conversation with Dr. Tina Moore is she's one of the first people to discuss the positive effects of GLP-1 outside of weight loss. It's pretty incredible the studies that are coming out about this drug.

And she also talks about the importance of dosing. It really seems like a lot of people are taking too much of this medication. I think we've all seen, you know, some of the influencers in LA who lose a ton of weight all of a sudden or, you know, people taking it who maybe shouldn't be or taking too much of it. She discusses the benefit of microdosing or cycling and

And she talks about that today. And I think a lot of people have questions about this drug. And she really, really got into detail. She also talked about things like addiction, which I think is just mind blowing. She made a comment about the homeless population and how potentially GLP-1 could be a helpful solution for people who really cannot break their addictive habits. And I just think that that's a really crazy concept. And honestly, I've been thinking about it ever since she said it.

So today's episode is really, really interesting. And I would just urge you guys to go into it with an open mind. I'm someone who...

I've heard a lot of different opinions on GLP-1. I've had people come on the show who say it's awful. Some people say it's beneficial. I think it's important to have an open mind, listen, you know, check out the studies, see for yourself. But this episode really sort of shifted my opinion on things a little bit and opened my eyes to people who could be benefiting from this in other ways. So

Before I get rambling, let's hop into this episode with Dr. Tina Moore. Just a reminder to subscribe or follow if you enjoy the episode, leave a review, let me know what you think, and let's hop right in. Dr. Tina, welcome to the show. Thank you for having me. I'm excited to be here. We've already been chatting behind the scenes and I'm just so excited to have Dr. Tina Moore.

a new fresh perspective on this topic. You've become known for being an advocate for microdosing semaglutide for benefits beyond just weight loss. So really excited to dig in there. You have an amazing resume. You're an expert in holistic regenerative medicine, resilient metabolic health. You're a licensed naturopathic physician and chiropractor and a podcast host. I don't know how you manage all of those things, but congratulations. Thank you. Thank you.

I'd love to start just by hearing how you got into this field to begin with. On the subject of GLP-1s in particular? Just in naturopathic medicine in general. So I was a very sick little kid. I was just, from the time I came out the chute, a very, very sick child, subjected to a lot of

interesting medical interventions and gaslit and ignored and didn't have my questions answered. Even as a child, I would ask good questions to doctors and they wouldn't answer me. And putting on a litany of drugs that many have since been taken off the market. And it turned out all in all, it was really just like low-key autoimmune nonsense happening for my entire life.

And I had to go through naturopathic medicine, the training process just to figure out what was wrong with me and what was going on. And really I became a naturopathic physician so that I could learn and help myself, which I think many of us go on the journey of medicine to do, but more importantly to protect my family because I knew the system as a whole, as we've really seen the past few years, is pretty busted. So to keep my loved ones out of that as much as possible because I don't like doctors...

I went down this route and then I specialized in regenerative injection therapies for the bulk of my career. And that involved obviously a lot of injections of natural substances into joints to regenerate them, but also...

bioidentical hormone replacement because that's a huge component of pain and immune modulation and then peptides. So getting into the GLP-1s was just a natural transition for me because I was like, "Oh, well this is just part of the toolkit," right? And it's a really powerful tool. And so I started incorporating that into my own personal life, really just discussing it with anybody who would listen, all of my colleagues.

I asked, are you guys trying this for anything outside of weight loss? Have you dove into the literature on this? Are you seeing what I'm seeing? And really it was just a lot of crickets and people wanting to utilize higher doses regardless. So we can talk about that, like the real concept of microdosing versus what a lot of doctors seem to be doing. Not to say it's wrong, but there's just some difference of opinions there. And all in all...

I'm thoroughly blown away with the impact. And while I don't have my big practice anymore, I cannot believe what a massive lever puller this one peptide is in particular. And I think...

Had I had this tool when I was seeing dozens of patients a week, I definitely would have utilized it more because it checks off all the boxes. At the beginning, when you first started incorporating it in your practice, what was some of the initial success stories you saw? Or was it yourself? It was me. Okay. Me and then my daughter wanted to try it. She, like many young women, had...

you know, an excess 20 pounds or so that just wouldn't come off. PCOS, just very common. This is so many young women's story right now. And I think it's because we are generationally into a pretty...

adulterated food supply and a toxic burden in the world and a litany of interventions that are applied to us as children. And I think that all that adds up to a lot of women struggling and then they end up in their 20s and 30s and dealing, they're maybe not even aware that that's what's going on and then they end up infertile. And this is a crisis right now that no one's talking about. Even the women doing all the things, right? Like...

everything, right. And then it still seems to be a problem. So I don't think people realize what's happening with fertility rates. It's insane. And it's a very emotional thing to go through. And I feel like I had zero understanding of just how I feel like in life, you can work really hard at things and make it happen. Like I feel like a lot of what I've done, I've just worked hard at.

And this is the first thing in my life where I feel like I'm working hard and it's not making a difference. And the more I talk about it publicly, the more responses I get from girls my age, older, younger, struggling with the same thing. And it's confusing when you eat healthy, exercise, do all the right things, sit in front of red light panels, like you do everything and it still doesn't work. Yeah. And then the social media influencers make you feel terrible because they have the one thing.

the one magic thing, you know, the one just do this and this is the way and just eat this way and do this. And it's just not that simple. Well, have you seen the trends of like mucinex? Girls are taking mucinex. Oh, wow. Just to thin out. I mean, I don't really know how it works, but. Probably to thin out. It's a, it's a mucolytic. So it's probably to thin out the mucus, which would change the composition of the mucus at the, at the cervix. Okay.

which would potentially change the entry of sperm ability. I mean, I might try it, honestly, at this point. On TikTok, you see all these things happening. Well, NAC is a mucolytic though. So NAC and iodine are both mucolytics. Okay, so you could take that too. Pretty potent ones. So I think I heard you, when you were speaking about your daughter's PCOS and how semaglutide helped her, I think you mentioned cystic acne too. Yeah, really severe cystic acne. And how does GLP-1 help with that?

I think it helps in a myriad of ways. So first and foremost, it impacts the immune system. That was what was most interesting to me. So for me personally, it was about the impacts on the neurologic system and on the immune system because I'm an autoimmunity girl and many of us are. I mean, I think my story is I was...

I was experiencing what so many young women are experiencing now, only I was an outlier in my generation. So I'm Gen X and I was one of the few and everybody's like, oh, you're fine, especially when you're thin and you look fit and healthy. They're like, what could possibly be wrong with you? And I've had so many neurologic immune driven issues. And so for me, that was it.

So the immune impact I think is huge. We are seeing overall some, definitely some impacts on the hormonal system because I don't know about the friends that you know that who have taken it, but women will often report shifts in their menstrual cycle as they adapt to the GLP-1. So even at really tiny doses, I'm noticing that to some degree, but it tends to normalize. So it's

It reminds me much like when women go on HRT when they're hitting menopause. There'll be like a 90-day adjustment period where they might have some breakthrough bleeding or they might have some shifts in their menstrual cycle. So it seems to be favorable, not unfavorable. It tends to regulate that out and make it become a little bit more normalized for the woman.

Or I shouldn't say normal, but just more predictable. Yeah. Because there's no definite number of what the perfect cycle is. I think that...

We see massive changes in metabolic health overall, which ultimately is what's driving PCOS. I think the confusing part is, you know, currently we have some folks going around on the podcast saying, oh, you can completely reverse PCOS with diet and you can do it in 12 weeks. And that's an incorrect statement. That study was actually 12 weeks ago.

of showing initial shifts in PCOS symptomology. It wasn't a cure-all. There's no button that we can push on PCOS to say this is it, fix your insulin resistance, it's gone. I wish it were that simple, but as someone who has actually been a treating physician for decades, it is not that simple. We have to pull several levers with PCOS and it really comes down to the individual and what's driving it for them. And I think what people don't appreciate is that

your mother's health is having a significant impact on whether you have PCOS or not. Hmm.

your grandmother's health. So this is an epigenetic lineage that's happening. And so young women today are experiencing infertility and their doctors are like, "Oh, here, just do this." And in fact some of the allopathic interventions are great, like spironolactone. I mean, some of those are wonderful because spironolactone lowers your androgens, which ultimately can help balance the hormonal profile, right? It's not that we want anything high or low, we just want it working in somewhat of a balance.

which is then going to impact your metabolic health. GLP-1s do a similar thing with the metabolic health. And ultimately, we have to pull several levers if we want to normalize out the

experience for that young woman. So I also think it helps rev the mitochondria, which is going to supercharge detox pathways. Yeah, that's true. There's a piece there too, right? So there's just all these different components. And I'm always thinking of simplicity and compliance. I mean, why would you want to take a litany of supplements and

pharmaceuticals and basically starve yourself into orthorexia because you're worried about all the food you're putting in your mouth at such a you know microscopic level of nuance or can we potentially bring in a peptide like glp-1 and have many of these systems regulate out so maybe you can have a glass of wine once in a while and live a normal life or maybe you can have a slice of pizza with your girlfriends when you go out and it's not you know you're not sitting there beating yourself up um

There's just, there's impacts here. And I'm not saying it's the lazy way out either. You know, it's just, why not? Why are we white knuckling things?

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Right. It's really interesting you say that with PCOS because so I had cystic acne on and off for 10 years of my life. And I was the person who was terrified of eating the wrong thing. I mean, like I was eating pretty much meat, fruit, and that was it. Yeah. And like weird coffee replacement. I was just doing all types of things because it was making me feel better. And like mentally, I thought that these foods were causing my acne, but it was so much deeper than that, I think. Yeah.

And I'm also, PCOS confuses me because I feel like there's no true,

I feel like everyone just has this like cluster of symptoms. I know I have like a high follicle count, for example. I've had acne. I've had hair growth. I've had different symptoms, but I live a very healthy, clean lifestyle. I have a regular menstrual cycle. I ovulate. I test for those things. But it's really intimidating when you get a PCOS diagnosis. You kind of feel like trapped in it and you don't really know how to move forward from there.

So very interesting that microdosing this semaglutide could be helpful for that because I think, I mean, I'm hearing tons of women responding

responding to my show telling me they have PCOS? I think it's a syndrome and unfortunately a syndrome is sort of a blanket umbrella statement in medicine where we're like, we don't know. But it really is. It's a culmination of symptoms and it's happening to a specific cohort of women. I was diagnosed with PCOS when I was 19 and I was skin and bones and didn't have any cysts on my ovaries.

So it's a terrible name in the first place because you don't have to have cysts on your ovaries. It was just one identifying feature of the disease process. And again, it's not a disease in my head. When a patient walks in and they say, oh, I have PCOS or I see a series of lab markers that are pointing to it. For example, my daughter was showing on labs, she was showing symptomology also at age six.

And I told my entire family she is going to have PCOS when she grows up if we don't intervene with, at the very least, the foods we're letting her eat. And because she was between households because I was divorced, everybody was sort of feeding her however they wanted. And I'm over here like watching a train wreck in slow motion, right? And so lo and behold, she hits her adult years and it's like, boom, we have PCOS. And with that comes...

I mean, she's 24 now, right? It's a decade. It's been a decade of really severe acne, which is devastating to your social life. It's devastating to your...

your courage and confidence and, you know, it's just, and then people want to start splitting hairs, whether it's okay to take a GLP-1. And I'm like, well, that's nobody's business. First of all, our medical decisions about what we do is nobody's business, never has been. I don't know why it was popularized in 2021 to suddenly start asking everybody about their personal medical information. But if we have something that we can apply that's inexpensive and

seemingly very safe. I mean, the safety profile in these peptides is showing itself to be pretty incredible and pretty cool data is coming out showing its protective mechanisms on all the things we're concerned it might be causing. And I do think that the dose matters here to some degree. We'll see. I mean, maybe even at the high doses that the studies are showing really great protection against certain things that seem to plague us as humans these days. So

What if we could do away with the whole arsenal? Like the average PCOS girly is on birth control, she's on spironolactone, she might be on an antidepressant, then there might be a metformin thrown in as she's getting a bit older. There's usually some weight that's stubborn that doesn't want to come off that's driving all the inflammation and it's just this vicious downward spiral for these girls and they end up my age and they're a complete disaster. So I'm over here like, hey...

Can we sprinkle a little GLP-1 on this and actually correct it? From a root cause perspective, it is healing. It's anti-inflammatory, it's healing, and it's regenerative to these tissues. So what if applying it to a younger woman might actually help her avoid that hot mess completely when she gets to be my age? And ideally remove some of those pharmaceuticals from the list. Yes. Mm-hmm.

I mean, or get them down to a dull roar of dosage, right? The very least that... That's always the goal is like let's improve lifestyle so that we can get all the pharmaceuticals, including the GLP-1. So you can dose that too high, you can eat right through it, you can drink yourself right through it, you can lifestyle yourself right through that low dose and it won't work anymore. So that's why it's so critical that people do all the other things so that we can keep the dosages of everything we're on super low. Yeah.

What other benefits have you seen low-dose GLP-1 doing for people? So we said hormones, obviously weight loss. What else have you noticed? So the metabolic implications are pretty huge and that's happening on a couple levels. We get improved insulin signaling, so it signals when it's supposed to. We get improved insulin reception, so the cells actually start to hear it instead of becoming insulin resistant.

We see certain metabolic pathways revved that are favorable for not only GLUT4 translocation, which is the ability of the cell to uptake glucose and use it as fuel, but improve mitochondrial performance. So like the AMPK SIRT1 pathways are favorably pushed with the use of GLP-1s. We see just sort of body-wide inflammation coming down, which is going to improve...

metabolic health overall. Metabolic health isn't as simple as like glucose into the cell and we want to make it... everyone here is about insulin resistance,

but that's not the only way that glucose gets into the cell. And then once it's in the cell, is it being utilized as fuel properly? That's up to the mitochondria. So all of those systems are favorably impacted with the use of GLP-1s. We start to see some of that inflammatory fat come off, particularly the visceral fat, which is driving, it's like a chicken and egg downward spiral when it comes to metabolic health.

We see this with young women with a PCOS, and I would say the mirror image of that in the older woman my age is when all of a sudden is what was happening to me, like, boom, 15 pounds around my midsection. Like, we all turn and I joke, and I don't mean this in any derogatory term, but you know how when you start to approach women,

puberty as a child and that like eight, nine-year-old girl, they all turn into little potatoes. You know what I mean? We all went through it. Like we all turn into a little potato shape for a hot minute. We turn back into a potato shape when we hit menopause or perimenopause. And that's insulin resistance. Mm-hmm.

So I'm over here waving the flag like, ladies, we got to jump on this. I've been telling my patients for decades, like you have to nip that in the bud, but we didn't have anything great to nip in the bud and we're doing the same thing as you were doing. We're doing all the things. There's no more levers to pull. And we induce this orthorexia into people, which is...

Just as bad. I mean, I am a lifetime survivor of anorexia and I've been through orthorexia and it's like you can't go out, you can't travel, you can't do anything without having... You feel like you live in a bubble. It's like a walking bubble. And we've glamorized it on social media. Like who can be the most restrictive? I only eat beef and salt. Yeah.

I've been there. I mean, I know exactly what you mean. Like I, when I think about living in LA and the way I used to live my life, I feel horrible for myself. Yeah, me too. Sad, it's sad. And now I feel like I can have a glass of wine or it's not about like, it's not about living an unhealthy life. It's about living with freedom. Right. And I think that there's,

friendship and food and there's culture and there's I I joke because every time I go to LA or any of the bigger cities to do podcasts my friends have all their friends are on like the higher doses of the GLP ones yeah and they're like it's no fun anymore nobody goes out to dinner nobody goes out for drinks like none of their girlfriends want to put anything in their mouth so they're literally dosing themselves into their orthorexia yeah so anyway I'm just arguing for a moderate

There's a middle ground, we have to live and we also have to keep ourselves in check. And we live in a current state of toxic soup on this planet and so all bets are against you as a woman because of the estrogen receptors that we have. These toxins act as xenoestrogens and so we're just kind of swimming through this. You were born into it, I was basically fed into it. I was the first generation with a really adulterated food supply when they really started messing with things.

And so for young women of your generation, I just feel terrible. Like I feel terrible the way you guys were. You came out of toxic moms. It's like dodging bullets. Yeah. And there's just so many young, and I'm not advocating that we, you know, throw children on GLP-1s, but there are some...

young girls out there coming into puberty and all bets are against them just by means of the fact that they were swimming in insulin in utero because their moms were so metabolically compromised and they're marked now genetically and epigenetically for life.

to have a significant risk for obesity and type 2 diabetes. And why are we waiting until people are obese or type 2 diabetic at all? Like there's decades in there where interventions could happen. So just on that, and again, I'm not arguing for GLP-1 as a weight loss tool. That is a whole other argument I could make. I could go on for hours about that. But

because obesity is complicated, but why are we waiting until people are so far down? I'm just over here saying, hey, we have a tool, let's just put it out on the table that personalized, individualized dosing, maybe not even call it microdosing, I kind of want to kick myself for...

spreading that term around because it's really just personalized, individualized, inclusive dosing. Yeah, right. Like what dose do you tolerate that's going to help you move the needle for the goals that you have which may have nothing to do with weight loss but it will always have something to do with metabolic health just by the state of the world we live in and why are we not discussing that as an option?

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I think sometimes when people hear metabolic health they think, "Oh, that doesn't apply to me because I'm not obese." Would you say that applies to everyone? -Yes. -Okay, how come? Well, 2018 data... let me just go back. I started in practice in 2008 and...

My mentor taught me to screen everybody because he was talking about metabolic health back in the 90s. He was like, "Get off the treadmill, lift weights, eat meat, avoid..." There was no carnivore diet, there was no paleo diet even. He was just like, "Stop eating white foods that are high in starch and carbs." Ahead of his time. Yeah, and he was telling me to keep a check on waist circumference at all costs

Keep a check on blood pressure, keep a check on waist circumference and make sure people are strength training to optimize their bone mass and their muscle mass. And, you know, live in moderation, get outside, make sure you get sunlight. I mean, all the things that are popularized now, like I was hearing this straight out of college in the mid-90s. So I go into practice and I start running metabolic markers on everybody and everybody has some version of compromised metabolic health. It's glimmers sometimes. It's not like full frank...

disaster zone. It's just, hey, you're headed down this path. And if we don't do something, like maybe we're seeing some changes in lipids. We're seeing some changes in serum insulin. We're seeing some changes in your blood sugar handling. We're seeing some changes in your inflammation. Maybe you're not able to get your vitamin D levels up because you're inflamed. Like these are all glimmers. And when they add up

together they add up to a story and then you look at the individual in front of you and how they literally appear and you take some measurements and some vital signs and then you take their history and you're like okay you are headed down this path and the only way to get out of that is everything i just mentioned and my my colleagues would give me shit they were like tina thinks everybody has metabolic dysfunction and here we are in 2024 2018 data showed that roughly you know

Gosh, 94% of US adults have busted cardio metabolic health that was pre-lockdowns, so God only knows what it is now. And so, yeah, I would say metabolic health concerns applies to everyone including children. And so it has nothing to do with what size you are. You can be skinny fat which is that thin on the outside, fat on the inside where you're just fat and bone. I saw this all the time in practice.

I don't know how many of your friends probably still the ones who brag, oh, I can fit in my jeans from high school, but they haven't seen the inside of a gym and they wouldn't know a squat if it hit them in the face, you know? And I'm like, well, good luck with your hip fracture when you're 80. Like have fun with that, right? I like that one. That's a good one. I'm going to pull that out. Have fun with that when you're, you know. And then I'm in the gym this morning at the hotel and we're at a pretty bougie hotel and it's awesome.

It's all these skinny women with their little dumbbells. I made a post about it on Instagram. I was like, ladies, we're trying to build bones in an ass. We're not trying to tone our arms. Like, what are you doing? You know, the word tone drives me insane. If people tell me they say the word tone to me, I'm like, what does that mean to you? Like, what is the definition of tone? Because what they what it actually means that you can see muscle.

And to get muscle, you have to lift heavy. Yeah. Yeah. I agree with you. It was literally a bunch of skinny, squishy women with little tiny dumbbells going like this, like doing this like angel thing for their arms sculpting. And I was like, oh my God, just go do some pushups. I'm glad you're saying this and not me because I agree with you, but I don't have to say it.

Pick up something heavy, do some squats. We're trying to build an ass because when you build your butt, the big muscles of your thighs and your booty are what keep your metabolic health in check. Metabolic disease starts in the thighs and butt. So for that middle-aged woman who was like, I used to have an ass and now it's completely flat. I don't know what happened. That's your insulin resistance starting. That's what's happening. And when you end up insulin resistant...

especially if you look at diabetics, they get the visceral fat and the big belly and then they start to atrophy in the appendages. It's a feed-forward mechanism. So you literally start to lose muscle mass in your legs and arms as your insulin resistance and your metabolic dysfunction is blooming, if you will, and then that makes it worse. So they end up frail, weak...

in the wrong places, even if they're still thin, they're still fat in the wrong places and then their bones are brittle and then, you know, that's my age cohort. This makes me feel better about having muscular legs because I feel like a lot of girls want stick legs because it's kind of the trend, you know? But I mean, helpful to know that having muscular legs is going to help us later in life too. Oh, every time I see pictures of you on Instagram, I text Drake and I'm like, she has such a great lower body. Yeah.

How do I get that? Oh, my God. Best case scenario for me, I'm like, I'm going to be the potato shape no matter what, you know? So I'm always over there like, how do I get hips and thighs? You are so far from a potato. You look amazing. Thank you. But I mean, I am prone to, my whole family is a bunch of little apples, you know, with little stick legs. And so, and no butt. And I'm like, I can't lose the booty trying to keep the thighs. You look great. Thank you. I always said I had rugby legs growing up because my dad's Welsh and...

He's got thick legs too. So I don't know, but I'm going to keep lifting weights. I feel good about it now. It's great. Trust me, this is going to help you age. And this is, you're going to be way better off than your skinny girlfriends when you're my age. Fee, that's us. Yeah.

I've also heard you say that GLP-1 can help with the microbiome. How does that work? And I think you told a story of your mother's Crohn's disease. How does that help the microbiome? So all the studies I'm finding show that it shifts the gut microbiome. So we have favorable organisms and we have pathologic organisms. I hate to make it that blanket of a statement though because I think of the gut microbiome

I think of everything as symbiotic until it's not. So everything has a place. Like we all have strep in our throats right now. It's just a matter when people say, oh, I got strep throat. I'm like, no, you have strep in your throat. It's just a matter of how your immune system is doing as to whether the strep gets to take hold and have a party. And so we have a...

mishmash of fungus and bacteria in our gut and they're all well and good until they're not. And so we never want one group to take too much power, kind of like our political system, right? We never want one group to take too much power. We want a balance in the force. And we have organisms that are favorable usually, but they can also be unfavorable. So we're always looking for the balance there. GLP-1 seemed to be that regulator, right?

best way I can put it from all the data that I'm looking at, that it just seems to shift the microbiome. I do think that when people start on these, there is a little breaking in period where they'll start to see a shift. A lot of people report that they actually have improvement in their bowel movements. So they'll say, "Wow, my bowel movements are way better formed, they're much more comfortable."

Others will say, now I'm constipated and it's uncomfortable. Others will get diarrhea and it takes a minute for that to sort out. I think that's the gut shifting. So I think if people are dosed too high too fast, it can be a really uncomfortable shift. And that's where we're seeing some of the nausea and vomiting. It's not just the GLP-1 directly impacting gut by slowing gastric motility or causing nausea. I think it's actually a die-off reaction of a lot of these

organisms in the gut getting shoved too fast. Interesting. So again, my reasoning behind slow and low, because we just want to nudge the system. So we want to nudge the individual who's taking whatever it is we're giving them and we want to nudge their microflora. That could be your skin microflora, that could be your gut microflora. We're just trying to like gently walk you down the line to better health and to optimization instead of like, hey, let me slam you with this, you know, and hit you with a brick.

So I think that there's potential for people to have a really difficult transition on these if it's done too abruptly. What are people doing wrong with Ozempic? Because I guess my first experience seeing it in action, I was living in LA when it got popular. LA is a very aesthetic place. There's a lot of models, people who make a living off of the way they look.

And a lot of like really lean girls getting on the medication and getting really, really skinny. What's like going on there? Are people addicted to it? Like let's talk about the way people are using it wrong. I think people are addicted to being thin. Yeah. Which I have been guilty of. Like it's pretty addictive. I do think too that –

There's such a profound impact on the brain with GLP-1s that people feel really good on it. And I dare say the word antidepressant, but for me and for others that I know, that has been a really favorable side effect is just this mood boost. And we have data to support that, of it reducing anxiety and improving mood pretty significantly. I think you can overdo it there and you can put yourself into this like

state of not wanting anything. And that's not great either. We don't want to overdose people into not wanting to eat, not wanting to seek joy, not wanting to have, you know, any kind of intimacy with their partners. Like you can go there too with it. But I think that

there's a sweet spot and they feel good and that part's addictive. You're always chasing the dopamine, right? And it does impact dopaminergic pathways and serotonergic. So we're getting serotonin and dopamine on board. So that might be the reason people think more is better. And then, of course, being really thin is... That's just been going on forever though. Like the whole being skinny addiction, like that has been popularized for many generations. It just comes in and out. I heard the other day that...

the Kardashian hips and butt image is out and now they're calling it the ballerina body and the, you know, the plastic surgery clinics. And I'm like, this is ridiculous. Like we're all built differently. Why don't we just optimize how we're built? Like our own. Doesn't it make you wonder like how long celebrities have been using a Zen pic? Oh yeah. You know? Yeah. Like I'm sure for longer than we realize. Yeah. Yeah.

Right. And now like we're watching influencers. I mean, people throw allegations around all the time and I don't think many people are open about it, but you can kind of tell when someone just suddenly dropped 30 pounds out of nowhere. Yeah. And what is that? So I obviously had a large weight loss journey in 2017 before Ozempic, which is really funny to think about. Like I've had a lot of people ask me like, would you have used it?

I don't know if I could have afforded it, but I'm almost, I'm glad I didn't have it then because I think I learned a ton. Like I wouldn't have learned what I learned if I had had that as a tool. But now I'm learning more about the other benefits it has. ♪

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I'm just curious, like these people dropping weight this quickly, like what are the side effects of that? Let's talk about that. So first of all, it induces neuroplasticity. So there's, your brain is rewiring when you're on it. So whatever you're doing in your lifestyle during that period is getting hardwired in, which can be really cool if you think about it. If this person is being supported with all the lifestyle changes and they have this window of opportunity to

to learn all the ways of taking good care of themselves through diet and nutrition and optimizing their sleep and all that jazz, then that's going to get more hardwired in. So they're creating new habits in a much more intense way, which is very cool. But if we go too far, especially too fast, you do end up losing muscle and you do end up losing soft tissue and you end up

potentially much worse off than you started. But again, that's been going on since the beginning of time. You know, back when I was a teenager, it was like Kate Moss and heroin chic. Everybody, we were all trying to be, I was guilty of it. I mean, we were bone thin. I was always, I have these big gymnast wrists because I, you know, from landing all the time in gymnastics. And I was always trying to make sure that my upper arm was as small as my wrists.

Wow. That is how I lived. That's crazy. So we just chain smoked our way into it. You're like, we use cigarettes. We just chain smoked and starved ourselves and lived off coffee. Great. Yeah. I wonder why I was sick all the time. So it induced all my autoimmune disease.

That's been going on forever though, you know, so this is just another tool. And you end up crashing out your metabolism for the long term. So now as I hit menopause, I am struggling with metabolic dysfunction, even with the best of intentions. I started training when I was 40. I wish I had found strength training earlier, but I didn't start until I was about 40 because I did not want to walk into menopause and have it be a total train wreck disaster. So I trained for menopause.

But even with the best of intentions, I still ended up with this like low key insulin resistance. And that's loss of estrogen too. I mean, there's other pieces to this puzzle, but that's what you do. You think about, I don't know if you remember any of the like rock goddesses from the 70s, like, oh, Stevie Nicks, of course, you know, and then Linda Ronstadt. And they were all super skinny and beautiful and they were all on cocaine. Yeah.

And that was the tool they used, right? We've all had our tool. So every generation has its tool. So my generation had fen-fen, right? Everybody had a tool to get themselves rail thin, but there is a cost to living at rail thin without muscle. And that is years later, your metabolism completely turns on you and it's a train wreck. So all of those women ended up ballooning and getting quite big, right? And so it's

It's a balance. The only way out truly is through muscle and good health and good nutrition. And then we have tools that we can use. So I think to answer your question, I think these women are just using the GLP-1 as the only tool. That's a disaster. Right.

And not changing their lifestyle with it. Oh, that's a disaster. But you know what? That's on them. Yeah. Like we all worry so much about what everyone else is doing. And I'm like, well, good luck. Like you're going to have diabetes and you're going to probably be overweight when you're 50. But have fun with, you know, definitely the osteoporosis. I'm just looking at all their bones. I'm looking at some of these celebrities that are so, so thin. And I'm like, oh, you're going to take a step wrong when you're my age. And it's not going to go well. Right. So I'm always thinking long game. Yeah.

For someone listening who maybe has been on semaglutide and has lost a lot of weight,

and is feeling really good about it, but now they are concerned about coming off of it, lowering their dose. I think a lot of people kind of feel stuck and they don't know where to go from here. What would you recommend they do moving forward? That's tough because they've acclimated their cellular receptors to needing that much of a substance. So that would be like a bodybuilder who's taken a ton of testosterone and then they end up in my clinic in middle age and they're like,

They really need some testosterone and they want physiologic dosing and that doesn't always work. Sometimes we have to keep things a little bit higher. So I guess it depends on how long they've been on it, how old they are, what their metabolic health is overall, how much muscle mass they've preserved. But you can titrate anything down, right? So this is again why I'm...

a proponent of keeping things slow and low. And when I talk microdosing, I'm talking like a fraction of the starting dose. A lot of these clinics and medispas are talking about using the standard starting dose and calling that a microdose. What's the starting dose? The standard starting dose of semaclutide is 0.25 milligrams and it's

2.5 milligrams of triseptide and they're starting people there and they may be jumping them up to the next tier and they're calling that a microdose. That is not a microdose in my opinion, that's a low dose, but that might be what that person needs. It depends on how compromised their metabolic health is. It's completely individualized for the person sitting in front of me. And then I have a whole litany of other things that go in there. So there's other peptides we use and there's hormones and we're treating them comprehensively. This is what I teach inside my course.

And it's a course for clinicians, but I let the general public in because this is a comprehensive treatment approach so that we can keep the GLP-1. It's just a tool in the tool belt. It's one of many. It's a huge tool and it's a big lever puller, but we want to keep that dose as low as possible. And so when folks are saying like, how do I get off of it? Or I stopped losing weight on it or it didn't work for me. I'm like, well, how are the rest of your hormones? How is your gut health? You know, how's your adrenal health? How's your thyroid? Right.

How's your strength training going? How's your muscle mass? These are all things that we have to consider because that's what needs to be in place. So when someone says, how do I get off this whomping dose I'm on? I'm like,

How's everything else going? Right. And focusing on all of those being in balance so that we can bring that down to the lowest dose necessary. If it's only used as a monotherapy and it's the only crutch we have, not great. That's not a great long-term strategy, in my opinion. I'm just thinking like, so...

you're a naturopathic doctor i feel like if these medispas and places where people are getting it from are putting people on these high doses to start yeah are they even reset like let's say you go i mean i mean fee has talked about her ozempic journey on here so i'm just going to throw fee under the bus right now but like fee is wants to explore microdosing and

Can she go to her regular doctor and say like, oh, I heard someone recommend this. I want to try it. I'm like, what could we recommend? Can people request that from their normal doctors? Like a normal doctor is going to understand that concept. I think any doctor who...

So I think doctors are inherently good. I think they get a bad rap. I think it's the system that's busted that they are forced to practice within that gives them a bad rap. And I think any doctor worth their salt who has a brain is always going to prefer a lower dose of any medication over a higher dose. So a reasonable doctor is going to happily agree to help you titrate down.

So just the idea of titrating down to the lowest minimal dose and I think people might be surprised, especially if they're young and healthy and active and they're eating well, the opportunity to get that dose lower is probably there. If we're talking about somebody who is older, like my dad, severely diabetic and overweight, I only have him on like half the standard dosing

journey though, you know, so semaclutide starts at 0.25 and it goes up to 2.5 and I've got him somewhere in the middle and we took a whole year to get there and he's having great weight loss and great success and great changes in his lab markers, so we're just going to stay there. So my argument to everyone listening, whether they're a health practitioner or just the general public is just go slow and low because you'd be really surprised how...

somebody may need. Although don't be afraid to give them something more if they need it. I'll give you an example. I have some colleagues who never really talked to me about my strategies and claim to be microdosing themselves. And they've got patients on these really low doses thinking that that's preferable. And maybe it's helping these folks with their

you know, autoimmune symptoms, but these folks have weight to lose and they do have metabolic dysfunction. And then I check in with these folks because I know them all and I say, "How's it going?" And they're like, "I haven't lost a pound. I haven't lost any weight." And I'm like, "Well, you need a higher dose. Why are you not taking a higher dose? You are more metabolically compromised." The healthier and more metabolically optimized someone is, the lower dose they need is what I found. But that's not--it's individualized.

I've got people who are full of muscle mass and eating super well and super healthy with very little weight to lose and a microdose doesn't move the needle. So we need to go to more of a standard dosing. So it's just a matter of working with the person and then the person being a proponent and an advocate for themselves and that's...

where getting educated comes in. That's why I have my course or all the free content I have out there about this is because like if you're educated, you're empowered. And I think that any therapeutic that you choose, whether it's hormones, peptides, all of it,

The better you go in, the more educated you are, the better conversations you're going to have with your doctor and the better you guys can work as a team. Because I've learned a ton from my patients over the years who came to me with ideas and strategies that they'd either read about or learned about somewhere else and I'm like, hey, yeah, let's try it out. As long as it's sound, it's not going to hurt anyone. We have some data to support it. But even if we don't, the reason I came out with this...

concept of utilizing these GLP-1s outside of weight loss and diabetes was because we had all this data showing that they had these impacts on different organ systems of the body. Why not? We are allowed to use things off-label, right? So just to wrap that all up, we're just titrating up to the minimal dose necessary or maybe titrating down. But for those who are really severely metabolically compromised who've been on very high doses for a long time, I don't know if there's going to be a

I don't know if microdosing is in their cards. And microdosing is not a weight loss strategy either. It might be for someone your age and of your health, but it's generally-- I'm getting a lot of pushback out there like in news articles and online people saying, "Dr. Tina said microdosing is amazing for weight loss and it's not working." And I'm like, "No, I never said that."

Actually, it's for other things if you are metabolically optimized. It can help you lose weight if you're metabolically optimized at the micro doses. But if we are talking about 30, 40, 50 pounds, we probably need a more standardized dose and we may need to go up a little bit.

I think there's like a gray area, right? And people don't really like to talk about the gray area. They want the black or the white. They want a definite answer. Are you a fan of cycling, of like going on, going off, going on, going off? Yes. I think cycling anything. So we're always trying to keep the receptors sensitized. We always want to make sure that the receptors hear what we're giving. So even with hormones, right? So with progesterone, we take the week of menstruation off.

I may even take time off in between estrogen dosing, depends on what we're using it for. Testosterone, same thing. I've got several patients in my career, I've had several patients that were young men who had histories of traumatic brain injury because maybe they played hockey or they were football players or whatever and they needed testosterone because they'd really done damage to their brain earlier in their life and that impacts your hormones down the line.

And they didn't want to be on it 24-7 because they wanted to have children and they wanted to be fertile. And so utilizing testosterone in a cyclical fashion, and that might be a couple times a year, it might be doing a cycle and then taking a cycle off. It might be with the GLP-1s, I've got people taking a couple weeks off in between shots. We've got people taking a couple months off. It really just depends on what we're using it for.

And what is the difference? Okay, there's Ozempic, Manjaro, Trizepatide, Wagovi? Okay, so semaclutide is the generic name. The FDA-approved drug version of that, which is...

That's your Ozempic. Ozempic isn't actually for weight loss, so it's kind of funny that everybody's throwing around Ozempic for weight loss. It's still semaclutide, it's just FDA approved for type 2 diabetes is Ozempic. FDA approved for weight loss is Wegovi. But it's all semaclutide.

And then we have truzepatide, which is the generic name of Manjaro, which is FDA approved for type 2 diabetes and Zetbound, which is FDA approved for weight loss. And now Zetbound comes in vial form, not just the pen. So there's opportunities for more individualized dosing there. Again, I...

I want to hit myself with the microdosing thing because that definition has gone. I mean, I've seen people on TikTok. They're like, I'm splitting up my dose throughout the week, so I guess I'm microdosing now. And I'm like, no, no, no, no, no. All I'm proposing is that we just consider individualized dosing because even in the realm of weight loss and type 2 diabetes, there's still some folks who cannot...

tolerate that standard starting dose, it makes them too nauseous and sick, why are we making them suffer until their body adapts or they get off of it and they say it's not for me. I think it's exciting that they're ZEP-bound now in a vial and we can use compounded, of course, but the vial gives us opportunity to individualize that dose. Right.

And why are people choosing certain forms of it than others? Like are some better than others? Is the price different? What's the differentiator? With the brand names there doesn't seem to be much of a price difference. It's all just exorbitantly ridiculously expensive, which is silly because there was a study that came out recently showing it costs like $5 to $7 for them to make it and then they're selling it through pharmacies for roughly $1,000, give or take, sometimes less, sometimes more.

The same exact drug is being sold in Germany and Canada for like a couple hundred bucks. So I don't know what's going on there, that's a whole other thing. The compounded version, semaclutide is easily the most affordable, terzepatide is three to four times as much in the compounded versions.

Somaclotide is just a GLP-1 agonist, so it sits on the GLP-1 receptor and it acts as GLP-1. It's basically bioidentical to our own endogenous bodily made. So we make GLP-1 in the gut and we make it in the brain and that's where it's used. It's used throughout the body, but the fact that was what got me excited. I'm like, wait, if it's made in the brain, there's probably a reason it's in the brain. That's not just appetite suppression, there's other things going on there.

So that's semaclutide, it just has been tweaked to keep its half-life longer. Endogenous naturally made GLP-1 is in and out, it's produced and then it's used up or becomes inert very quickly within hours and the semaclutide is good, the half-life on it is like four to seven days.

And then Terzepatide is a GLP-1 agonist and a GIP. So it's acting on glucagon as well directly. I think the implications there...

are going to be more applicable to those struggling with a bit more insulin resistance and a bit more metabolic dysfunction. So your PCOS girlies are probably going to find some benefit with that GIP. Interestingly, with glucagon, whether we agonize it or antagonize it, it seems to have good impacts on the body. So we don't have anything. We have some coming to market, it looks like, that might

impact glucagon the opposite way and still have a favorable impact on the GLP-1's ability to do good things in the body. So that's a nerdy way of saying we don't entirely understand how these are working, but it's pretty cool that we have that little extra added. I will say though in somebody like myself...

Teresapetide can really bottom out the blood sugar. And so that's something that I have several women that I know that are my age who you would look at them and be like, oh my gosh, phenomenal figures, six-pack abs still, really, really great muscle mass and physiques.

doing everything right, eating like saints, and all of a sudden their blood markers, their blood sugar handling is starting to get wonky. And that's just part of the transition into menopause. And they've got familial stuff going on and it's really frustrating for them. And so we try a Terzepatide and a little bit too much can be a lot too much in those folks because all of a sudden they're calling me freaking out and I'm like, check your blood sugar, and it's just bottomed out. Mm-hmm.

And it can hit you at the most inopportune times where I'm like driving and I have to pull over and eat something. So that GIP, that's what I'm getting at. Having that on board can really start to impact the insulin and sometimes it's not so favorable. So those are folks that I might try going to the semaclutide and saying maybe that's

more appropriate. Okay. It depends though. Some people love the semaclutide, some people love the terzepatide. It just depends on how they feel on it. I don't like semaclutide. It makes me super nauseous. Terzepatide doesn't seem to have the same impact. So I just do what works best. And again, price, what's...

not only affordable but long-term, like what can they sustain, right? And so when we start anybody on a medication, I think it's really important to ask those patients because they might get excited and they can do it right now, but is this something that you can sustain affordably? And when we're talking microdosing with the semaclutide,

at the doses I'm talking about that might be like $30 to $50 a month, really affordable with the potential of not needing other medications maybe. Maybe it does away with some of these others and so when people say, "Oh, it's so expensive," I'm like, "Well, it depends on what context we're talking in because I've got folks who were spending $30 to $50 a month on their semaclutide and they're not having to spend all this other money on all these other things."

I've also heard it's very beneficial for drug, alcohol addiction, binge eating. Why does it help with those problems? So it plays on our dopamine pathways and...

Really interesting. Again, I think too much can sort of bottom out those pathways and make you not want anything. The term for that is anhedinia where you just are sort of like apathetic and you don't care and you don't want anything. I remember when I first started on them I was like, oh, I'm taking too much because I don't even want chocolate. I love dark chocolate and I didn't even want it. I didn't want anything. I didn't want wine. I didn't want food. I didn't want anything. And so...

When we impact the dopamine pathways, it gives us the onus of control back. I think that's what's happening. And so people are in the driver's seat again. And so I've had multiple people... I don't have a following your size, but I have a pretty sizable following and I'm getting feedback from tons of people online. And it's been wild. People are telling me they're not...

addicted to their social media anymore. They're not addicted to online shopping. They're just suddenly they have control back over whatever their dopamine dragon was, as I call it. And so some people like their alcohol. Some people like their marijuana. Some people like smoking. We've got data coming out looking at opioid use. I found this one gentleman who I can't think of the name of his blog right now, but he's written these incredible blogs on Substack

talking about the potential use of GLP-1s to impact the homeless problem that we're having because a lot of these folks are drug addicts on the street or they become drug addicts on the street, it sucks living out there. And I'm from Portland, we're like this is a huge issue and it's really difficult to get medications in folks that are homeless because of compliance, like they don't remember to take it every day or maybe they don't have access.

but the thought of an inexpensive GLP-1 once a week dosing to give them the onus of control back. I mean, there's just these implications when you give people control back over their brains, who knows what they will choose or not choose to do. Although I do think you can, again, you can eat through it and you can drink through it.

So if you override that, it's not like it shuts it off completely. It just dials it down. Right. And that might be enough for somebody to step back into their willpower. Yeah. Because willpower is fleeting. But it's just a tool to give them a bit more of that leg up. Yeah.

Yeah.

I'm sure a lot of people listening are wanting to run and start microdosing. So I'm a glue tide now. So what would you say to those people who are now eager to start doing this? What should they do first?

First, make sure you have the foundations in place. And so this is twofold though. Some folks are in such a bad place that getting the foundations in place seems daunting and overwhelming. And this is where people say, well, when do we bring in the GLP-1? And I'm like, it depends because if you need a little leg up to get started, it really can help.

I've noticed a lot of folks go on it and they just want to start moving after a while. After a while the body just wants to start moving, they feel better, and so it's a great tool to get people rolling in the right direction. However, the basics are always necessary: the sleep optimization, the strength training, the circadian rhythm, you know, going outside and getting daylight throughout the day,

making sure that we have stress mitigation and mindfulness in place. Those are all critical and non-negotiable whether you're on a GLP-1 or not. And I think that once the commitment is made to-- and I see people though, they say, "Oh, I promise I'll do that." And then they just rely on the GLP-1 and don't do any of the things. So we got to do all the things.

And I think it starts with education. So podcasts like yours and making sure... You know, I have a ton of free content on my podcast and on my Instagram and just making sure that you know what you're getting into, first of all. And then talking with your doctor. Start with your doctor. This...

Concept is getting out there since I've been on the podcast, so thank you for giving me an audience to say it to because I think more importantly I just want the doctors understanding that there's opportunity here for them to help their patients in a different way than maybe they thought they could. And so finding a doctor who's open

to having this discussion, start with your own doctor. If they're not, then keep looking. I really don't love the idea of MediSpas doing this, to be honest. I think that this is not a here's your injections and good luck. Like this is a comprehensive strategy if we really want this to work well for the long term. So it's short-term goals, long-term goals, right? It's like the short-term obvious, long-term not so obvious. You're a businesswoman, you know, we understand that. So...

I have a video, a free video on my website on how to find a good doc that people can get started. I have a whole in-depth module inside my paid program. And then I have a four-part video series that people can opt into. And it's basically part one is...

just the ways that GLP-1 impacts the body that we really didn't entirely get into that are favorable besides weight loss. I talk about all the big scaries where I dispel all the myths because I think there's a lot of myths to dispel. And then just other interesting information that they should have as education. And then I have my paid program if they're interested in that. So lots of free content. Where can they find all of your podcasts, your resources? Yeah.

Dr. Tina.com. So it's D R T Y N A. And then I'm on Instagram. I'm on YouTube and I have, gosh, I think like 12 or 14 hours of free content just on Ozempic and the topic of GLP ones between all of it. So incredible. Yeah. Final question that I ask every guest. Yeah. What does wellness mean to you? Wellness to me, it means freedom.

If I don't have my health, I don't have anything. I am someone who struggles with chronic pain, so if I don't have my health, I have pain. And pain is just misery and you do nothing.

really it's freedom. I work every day to stay healthy and optimized so that I can have as much medical autonomy as possible in my life. Fantastic. Thank you so much for coming on the show. Yes. Thank you for having me. Thanks for joining us on the Pursuit of Wellness podcast. To support this show, please rate and review and share with your loved ones.

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This is a Wellness Lab production produced by Drake Peterson, Fiona Attucks, and Kelly Kyle. This show is edited by Mike Fry and our video is recorded by Luis Vargas. You can also watch the full video of each episode on our YouTube channel at Mari Fitness. Love you, Power Girls and Power Boys. See you next time.

The content of this show is for educational and informational purposes only. It is not a substitute for individual medical and mental health advice and does not constitute a provider patient relationship. As always, talk to your doctor or health team.