hi folks this is Dr Rob CIS I am the carb addiction Doc and as you've probably seen on this channel a few times and and there's huge controvery in the I hope that's the American saying of that word but it might be the English English saying of the word controversy in the uh ketogenic world and the world in general whether or not we should be using OIC and gp1s or how bad they are or how beneficial they are so I wanted to break this down and we use them quite a bit in my practice to
treat obesity to treat diabetes treat cardiovascular disease to treat Alzheimer's Even in our type 1 diabetics we use them to treat insulin resistance which is the cause of the majority of the metabolic diseases even PCOS when women are infertile far better than putting you on Metformin so there are tremendous benefits in my opinion and in my practice evidentially so this is not just my belief this is the evidence is there to using gp1s to treat insulin resistance however however when a doctor writes a prescription and says here you go off you go go be skinny
go get rid of your diabetes and it's monotherapy that's where the harm comes in that's where the failures come in so if you look at the step four trial data this was a study where they put people on oek uh for a period of a year and then they took half those people and they put them on a placebo for for another 48 weeks for the second part of the year and others stayed on the gp1 they showed at the end of the uh um the gp1 period a weight loss of 10.9% so if if
you were a 200 adult you would have lost 20 they then showed over the ensuing 48 weeks less than a year a 7.9% increase regain of that weight so over the course of 48 years so about 10 or 48 months so about 10 or 11 months you'd regained 14 or 15 of the 20 you lost and by a year or a little bit longer than a year not only you regained that weight but you've regained more than you should have more than you started with so there's a rebound weight regain and the reason for that
is because it was used as a monotherapy as a single therapy off you go calories in calories out exercise a little bit and it doesn't work because you haven't changed why you gained the weight in the first place same thing with the diabetes um it does treat insulin resistance but the the result Fades unless you work with it it's an it's an integrated approach um so the GP ones have have fallen on hard times plus if you use them as monotherapy and you don't change your behavior you feel miserable when you eat carbohydrates you have
acid reflux your bowels don't work you got gastroparesis you're throwing up you're miserable and also if you use it for a long time your muscles waste away why because you're eating a plant-based diet you're not eating adequate protein you're not able to metabolize that so a lot of negatives have happened despite the fact that this is the single most effective non dietary manipulation of insulin resistance it is an incredibly powerful drug and I will tell you it's as powerful as bariatric surgery as obesity surgery and I'm a bariatric surgeon so these drugs are incredibly powerful
we use them a lot in our practice but always multimodally so what I'm going to talk about now is what the best strategy is if you are going to use a glp1 and these are certain absolute musts in my opinion not only to reduce the side effects and make drug more I'm sorry I've got a cold so I'm sniffling a little bit um don't send your your kids to preschool um uh it cannot be Co because we don't have Co in the State of Florida that doesn't exist by the way um but no it's not
Co so the the point is and I apologize for my siing is that if you're going to use these medications and I'm a strong believer that they are an excellent Resource as a tool to help you on a journey not as an Outsourcing but if you're going to do this glucose GP one receptor agonists or other INR medications majara that kind of thing and the new ones coming down the peak there are certain things that you must do to prevent the side effects or reduce the side effects to incrementally increase the benefit and towards sustainability
and this is my list I personally am obesogenic in other words if I walk past the donut I'm going to gain 5 pounds weight gain is the way my body protects me from sugar so one of the things I've changed apart from being on a ketogenic diet I like to suppress or reduce caloric consumption and as such I have created Mondays as no calorie Mondays but as you know you never want to White Knuckle your way through a fast to a 48 hour fast so there are times when it's easy and it's straightforward there times
when I'm really dragging particularly if I'm not in ketosis where I'm exhausted that's when I'll use a ketone IQ Ketone IQ Cheryl and myself found is the best formula to rapidly promote a keto enic bloodstream where I've got ketones in my blood work not a big spike but a gradual rise that lasts about 5 hours and I may use this in the morning of that fasting although I'll often use my coffee but the time I most struggle is in the evening when I'm about to have dinner but I don't want to have dinner and I'll
hit one of these guys it'll help me to Cross to the next day if I'm in ketosis the next day I'm good to go may use one again the next morning but I strongly strongly support Ketone IQ to help you through your fasting so before we go through the list I just want to tell you what the benefits of gp1s are glp1 is a natural hormone that get freed by the gut what this medication does is it makes that effect more powerful so first and foremost in the intestine yes it slows down the rate of
emptying of the intestine but that's what bariatric surgery does even more powerfully you put a balloon in your stomach your band a bypass as sleep it slows down the rate of which you you move you eat less often well if you stuffing your face all the time it's going to clash and you're going to throw up you're going to feel miserable so but if you change how much you're eating and how often you're eating then you're going to use the gastroparesis that delayed emptying the slowness of the gut that is caused by these GP ones
as a benefit to drop weight to to reduce your insulin resistance so use that beneficially but yes in the gut they do slow down gastric emptying but that is not permanent that gastroparesis is not permanent and in fact diabetes is by far the commonest cause of gastroparesis so diabetes slows down the gut anyway ask any type one diabetic who's been diabetic for a while they all have gastroparesis so don't blame the medication for it the medication's supposed to do that but it goes away when you come off the medication so the gut empty you're not
going to poop as much but that's okay don't eat as much change your behavior we'll get to that the most important effect for me is the effect glp1 has on the pancreas and the liver in the pancreas it increases insulin secretion so you get a bump in insulin and remember type two diabetes is where you're hyperinsulinemic but you can't you're producing less insulin than you are insulin resistant so it increases insulin secretion it also decreases glucagon secretion so glucagon paradoxically does not add sugar to your bloodstream and Insulin clears it more clears it better so
you reduce your blood sugar it increases the the production of insulin in the pancreas now obviously if you're a type 1 diabetic we're using it exclusively to decrease glucagon because you're not producing insulin it increases be beta cell proliferation beta cells are the ones that produce insulin and it reduces death of those beta cells so it has massive profound effects together with a a new hormone that they're exploring right now called amalin in terms of regulating insulin and glucagon production in the pancreas in the liver because it reduces GL uh uh uh glucose production it
sorry reduces glucagon it reduces glucose production reduces the production of glucose from amino acids from protein and reduces the release of stored glycogen from the liver in the muscles it promotes sugar uptake which is an insulin effect so it promotes glucose uptake and storage in the muscles so you're Distributing sugar to your muscles rather than having it lie around in your F in your bloodstream or your fat cells it does also increase the amount of fat that gets deposited in the fat cells but because you're eating less you're actually using fat rather than the other
way around it is cardioprotective in the heart it improves cardiac function decreases blood pressure in the brain it is protective insulin is active in the brain and it is neuroprotective in the brain and decreases appetite centrally in the brain as well as the stomach so the glp 1es are Prof it also benefits from an immunologic system so gp1s have an effect on pretty much every important organ in the human body beneficial effect so how do we reduce the nasty side effects number one if you are going to use a glp1 Agonist make sure that you
are enrolled in a metabolic physician supervised program with regular visits in my practice those visits are with me personally as well as Cheryl our certified diabetic educated dietitian and those visits help you to change your behavior help you to change your diet to fit better with a gp1 Agonist so that you are embracing the medication and bringing your side to the table we give you that guidance and we give you the support very very important okay remember that AA does not get people to quit drinking AA helps people who did quit drinking to change their
behavior so that they don't relapse back to drinking again that's what we do in the office secondly a medication must you must be on a low carbohydrate high fat diet but that's more Omni carnivore or carnivore even vegetarian you want to make sure that you are getting in adquate protein because otherwise you will have the muscle loss and you want to protect that protein with adequate fat so protein and fat is your micros and then also making sure you're getting adequate micronutrients into your diet because you're eating less you're losing weight rapidly you still need
to get banged for your buck so if you're eating salads all day long it is not if you own eating a small salad because you can't eat more that's problematic nutritionally not because I'm against vegans or vegetarians but because there's not adequate nutrition in there if you're eating an egg if you're eating some fish or seafood if you're eating a steak there's much better nutrition in that food to the extent that you can and I recognize some people are limited by their physical limitations but to the extent that you can you must be in an
intentionally Physically Active program where frequency the frequency with which you are intentionally physical act Physically Active matters far more than the intensity I don't care whether you go to the gym or not but I want you to go for a walk I want you to be opportunistically and intentionally Physically Active because that protects your muscles protects the other things and also changes your mindset you absolutely must if the the effect is going to be sustainable being a cognitive behavioral therapy AA for fat people and in our program you want to have at least one visit
with eron our psych our psychiatric nurse practitioner not to talk about you being crazy we know you're already crazy okay we know that for a fact no this is to help you to understand the behavioral changes the uh uh addiction or the substance abuse aspect Because by the time you're obese or have type two diabetes and you're using the glp1 for that your relationship with sugar and starch is out of control no matter what you think and that behavioral change um supported by eron from the psychologic perspective is as important as the diet changing why
you're eating is as important as changing what you're eating my job is to monitor blood work and a must for me if you're going to use a gp1 Agonist to is to to monitor your blood work to see what your baselines are and then to monitor that blood work and to make changes as we go and we also help you the final step at home is to monitor your blood glucose to monitor your ketones either with a keto Mojo or a Dexcom CGM to monitor your blood pressure to monitor your heart rate and to monitor
your cardiac Rhythm if you are not doing that then you might as well rub your glp1 on the wall rather than swallowing it you won't have all the side effects because the long-term benefit is just not going to be there and all of my patients are experts at failing weight loss programs and for the majority of people that use glp1 Agonist prescribed by their doctors as monotherapy they become part of that population oh Kay I lost a lot of weight but I gained it all back please don't be a victim of monotherapy if you are
interested in our program uh look at the show notes but you can reach out to us WhatsApp or text us to 561- 517 0642 we will prescribe the medication in the context of our program but please do yourself the favor if you're going to take these medications of before you take the medication enrolling in a self-managed program of change if you don't change who you are the medication is not going to do that for you please understand that it's hard work but being fat being diabetic being sick half dying or dying is far harder than
the behavioral changes that we're asking you to make so text us WhatsApp us set up a visit we'll do the blood work we'll arrange the monitoring program and if you like our content if you like this I don't even mind if you try this alone at home but manage it in that way find somebody else who does this in a similar way leave us a dollar PayPal account hit subscribe to hear more of what we're doing like us uh leave a comment and we really appreciate the comments thank you so much
