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hi folks this is Dr Rob CIS I am the
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carb addiction Doc and as you've
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probably seen on this channel a few
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times and and there's huge controvery in
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the I hope that's the American saying of
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that word but it might be the English
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English saying of the word controversy
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in the uh ketogenic world and the world
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in general whether or not we should be
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using OIC and gp1s or how bad they are
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or how beneficial they are so I wanted
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to break this down and we use them quite
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a bit in my practice to treat obesity to
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treat diabetes treat cardiovascular
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disease to treat Alzheimer's Even in our
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type 1 diabetics we use them to treat
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insulin resistance which is the cause of
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the majority of the metabolic diseases
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even PCOS when women are infertile far
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better than putting you on Metformin so
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there are tremendous benefits in my
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opinion and in my practice evidentially
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so this is not just my belief this is
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the evidence is there to using gp1s to
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treat insulin resistance however however
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when a doctor writes a prescription and
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says here you go off you go go be skinny
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go get rid of your diabetes and it's
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monotherapy that's where the harm comes
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in that's where the failures come in so
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if you look at the step four trial data
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this was a study where they put people
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on oek uh for a period of a year and
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then they took half those people and
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they put them on a placebo for for
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another 48 weeks for the second part of
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the year and others stayed on the gp1
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they showed at the end of the uh um the
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gp1 period a weight loss of
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10.9% so if if you were a 200 adult you
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would have lost
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20 they then showed over the ensuing 48
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weeks less than a year a
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7.9%
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increase regain of that weight so over
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the course of 48 years so about 10 or 48
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months so about 10 or 11 months you'd
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regained 14 or
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15 of the 20 you lost and by a year or a
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little bit longer than a year not only
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you regained that weight but you've
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regained more than you should have more
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than you started with so there's a
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rebound weight regain and the reason for
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that is because it was used as a
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monotherapy as a single therapy off you
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go calories in calories out exercise a
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little bit and it doesn't work because
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you haven't changed why you gained the
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weight in the first place same thing
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with the diabetes um it does treat
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insulin resistance but the the result
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Fades unless you work with it it's an
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it's an integrated approach um so the GP
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ones have have fallen on hard times plus
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if you use them as monotherapy and you
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don't change your behavior you feel
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miserable when you eat carbohydrates you
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have acid reflux your bowels don't work
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you got gastroparesis you're throwing up
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you're miserable and also if you use it
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for a long time your muscles waste away
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why because you're eating a plant-based
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diet you're not eating adequate protein
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you're not able to metabolize that so a
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lot of negatives have happened despite
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the fact that this is the single most
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effective non dietary manipulation
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of insulin resistance it is an
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incredibly powerful drug and I will tell
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you it's as powerful as bariatric
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surgery as obesity surgery and I'm a
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bariatric surgeon so these drugs are
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incredibly powerful we use them a lot in
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our practice but always multimodally so
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what I'm going to talk about now is what
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the best strategy is if you are going to
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use a glp1 and these are certain
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absolute musts in my opinion not only to
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reduce the side effects and make drug
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more I'm sorry I've got a cold so I'm
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sniffling a little bit um don't send
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your your kids to
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preschool um uh it cannot be Co because
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we don't have Co in the State of Florida
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that doesn't exist by the way um but no
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it's not Co so the the point is and I
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apologize for my siing is that if you're
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going to use these medications and I'm a
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strong believer that they are an
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excellent Resource as a tool to help you
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on a journey not as an Outsourcing but
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if you're going to do this glucose GP
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one receptor agonists or other INR
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medications majara that kind of thing
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and the new ones coming down the peak
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there are certain things that you must
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do to prevent the side effects or reduce
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the side effects to incrementally
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increase the benefit and towards
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sustainability and this is my list I
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personally am obesogenic in other words
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if I walk past the donut I'm going to
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gain 5 pounds weight gain is the way my
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body protects me from sugar so one of
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the things I've changed apart from being
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on a ketogenic diet I like to suppress
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or reduce caloric consumption and as
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such I have created Mondays as no
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calorie Mondays but as you know you
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never want to White Knuckle your way
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through a fast to a 48 hour fast so
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there are times when it's easy and it's
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straightforward there times when I'm
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really dragging particularly if I'm not
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in ketosis where I'm exhausted that's
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when I'll use a ketone IQ Ketone IQ
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Cheryl and myself found is the best
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formula to rapidly promote a keto enic
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bloodstream where I've got ketones in my
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blood work not a big spike but a gradual
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rise that lasts about 5 hours and I may
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use this in the morning of that fasting
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although I'll often use my coffee but
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the time I most struggle is in the
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evening when I'm about to have dinner
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but I don't want to have dinner and I'll
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hit one of these guys it'll help me to
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Cross to the next day if I'm in ketosis
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the next day I'm good to go may use one
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again the next morning but I strongly
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strongly support Ketone IQ to help you
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through your fasting
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so before we go through the list I just
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want to tell you what the benefits of
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gp1s are glp1 is a natural hormone that
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get freed by the gut what this
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medication does is it makes that effect
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more powerful so first and foremost in
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the intestine yes it slows down the rate
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of emptying of the intestine but that's
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what bariatric surgery does even more
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powerfully you put a balloon in your
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stomach your band a bypass as sleep it
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slows down the rate of which you you
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move you eat less often well if you
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stuffing your face all the time it's
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going to clash and you're going to throw
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up you're going to feel miserable so but
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if you change how much you're eating and
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how often you're
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eating then you're going to use the
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gastroparesis that delayed emptying the
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slowness of the gut that is caused by
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these GP ones as a benefit to drop
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weight to to reduce your insulin
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resistance so use that beneficially but
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yes in the gut they do slow down gastric
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emptying but that is not permanent that
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gastroparesis is not permanent and in
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fact
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diabetes is by far the commonest cause
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of
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gastroparesis so diabetes slows down the
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gut anyway ask any type one diabetic
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who's been diabetic for a while they all
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have
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gastroparesis so don't blame the
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medication for it the medication's
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supposed to do that but it goes away
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when you come off the medication so the
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gut empty you're not going to poop as
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much but that's okay don't eat as much
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change your behavior we'll get to
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that the most important effect for me is
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the effect glp1 has on the pancreas and
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the liver in the
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pancreas it increases insulin secretion
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so you get a bump in insulin and
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remember type two diabetes is where
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you're hyperinsulinemic but you can't
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you're producing less insulin than you
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are insulin resistant so it increases
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insulin secretion it also decreases
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glucagon secretion so glucagon
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paradoxically does not add sugar to your
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bloodstream and Insulin clears it more
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clears it better so you reduce your
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blood sugar it increases the the
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production of insulin in the pancreas
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now obviously if you're a type 1
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diabetic we're using it exclusively to
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decrease glucagon because you're not
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producing insulin it increases be beta
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cell proliferation beta cells are the
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ones that produce insulin and it reduces
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death of those beta cells so it has
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massive profound effects together with a
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a new hormone that they're exploring
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right now called amalin in terms of
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regulating insulin and glucagon
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production in the
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pancreas in the liver
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because it reduces GL uh uh uh glucose
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production it sorry reduces glucagon it
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reduces glucose production reduces the
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production of glucose from amino acids
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from protein and reduces the release of
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stored glycogen from the liver in the
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muscles it promotes sugar uptake which
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is an insulin effect so it promotes
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glucose uptake and storage in the
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muscles so you're Distributing sugar to
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your muscles rather than having it lie
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around in your F in your bloodstream or
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your fat cells it does also increase the
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amount of fat that gets deposited in the
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fat cells but because you're eating less
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you're actually using fat rather than
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the other way
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around it is cardioprotective in the
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heart it improves cardiac function
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decreases blood pressure in the brain it
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is protective insulin is active in the
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brain and it is neuroprotective in the
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brain and decreases appetite centrally
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in the brain as well as the stomach so
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the glp 1es are Prof it also benefits
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from an immunologic system so gp1s have
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an effect on pretty much every important
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organ in the human body beneficial
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effect so how do we reduce the nasty
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side effects number one if you are going
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to use a glp1 Agonist make sure that you
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are enrolled in a metabolic physician
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supervised program with regular visits
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in my practice those visits are with me
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personally as well as Cheryl our
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certified diabetic educated dietitian
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and those visits help you to change your
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behavior help you to change your diet to
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fit better with a gp1 Agonist so that
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you are
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embracing the medication and bringing
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your side to the table we give you that
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guidance and we give you the support
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very very important
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okay remember that AA does not get
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people to quit
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drinking AA helps people who did quit
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drinking to change their behavior so
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that they don't relapse back to drinking
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again that's what we do in the office
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secondly a medication must you must be
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on a low carbohydrate high fat diet but
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that's more Omni carnivore or carnivore
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even
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vegetarian you want to make sure that
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you are getting in adquate protein
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because otherwise you will have the
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muscle loss and you want to protect that
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protein with adequate fat
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so protein and fat is your micros and
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then also making sure you're getting
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adequate micronutrients into your diet
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because you're eating less you're losing
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weight rapidly you still need to get
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banged for your buck so if you're eating
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salads all day long it is not if you own
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eating a small salad because you can't
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eat more that's problematic
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nutritionally not because I'm against
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vegans or vegetarians but because
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there's not adequate nutrition in there
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if you're eating an egg if you're eating
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some fish or seafood if you're eating a
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steak there's much better nutrition in
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that food
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to the extent that you can and I
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recognize some people are limited by
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their physical limitations but to the
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extent that you can you must be in an
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intentionally Physically Active
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program where frequency the frequency
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with which you are intentionally
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physical act Physically Active matters
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far more than the intensity I don't care
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whether you go to the gym or not but I
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want you to go for a walk I want you to
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be opportunistically and intentionally
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Physically Active because that protects
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your muscles protects the other things
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and also changes your
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mindset you absolutely must if the the
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effect is going to be sustainable being
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a cognitive behavioral therapy AA for
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fat people and in our program you want
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to have at least one visit with eron our
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psych our psychiatric nurse practitioner
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not to talk about you being crazy we
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know you're already crazy okay we know
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that for a fact no this is to help you
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to understand the behavioral changes the
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uh uh addiction or the substance abuse
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aspect Because by the time you're obese
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or have type two diabetes and you're
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using the glp1 for that your
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relationship with sugar and starch is
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out of control no matter what you think
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and that behavioral change um supported
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by eron from the psychologic perspective
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is as important as the diet changing why
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you're eating is as important as
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changing what you're
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eating my job is to monitor blood work
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and a must for me if you're going to use
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a gp1 Agonist to is to to monitor your
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blood work to see what your baselines
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are and then to monitor that blood work
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and to make changes as we go and we also
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help you the final step at home is to
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monitor your blood glucose to monitor
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your ketones either with a keto Mojo or
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a Dexcom CGM to monitor your blood
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pressure to monitor your heart rate and
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to monitor your cardiac Rhythm if you
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are not doing that then you might as
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well rub your glp1 on the wall rather
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than swallowing it you won't have all
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the side effects because the long-term
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benefit is just not going to be there
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and all of my patients are experts at
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failing weight loss programs and for the
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majority of people that use glp1 Agonist
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prescribed by their doctors as
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monotherapy they become part of that
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population oh Kay I lost a lot of weight
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but I gained it all
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back please don't be a victim of
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monotherapy if you are interested in our
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program uh look at the show notes but
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you can reach out to us WhatsApp or text
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us to 561- 517
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0642 we will prescribe the medication in
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the context of our
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program but please do yourself the favor
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if you're going to take these
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medications of before you take the
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medication enrolling in a
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self-managed program of change if you
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don't change who you are the medication
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is not going to do that for you please
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understand that it's hard work but being
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fat being diabetic being sick half dying
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or dying is far harder than the
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behavioral changes that we're asking you
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to make so text us WhatsApp us set up a
00:14:10
visit we'll do the blood work we'll
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arrange the monitoring program and if
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you like our content if you like this I
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don't even mind if you try this alone at
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home but manage it in that way find
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somebody else who does this in a similar
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way leave us a dollar PayPal account hit
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subscribe to hear more of what we're
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doing like us uh leave a comment and we
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really appreciate the comments thank you
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so
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much
