GLP-1s and Midlife Metabolism: Dr. Rocio Salas-Whalen Breaks Down the Science of Weight Loss and Menopause: Part 1

25:03If somebody gets on a scale and gives us a total number, we cannot make the right recommendations, right?

25:09Dr. Mary Claire Haver:So when I was training, again, that's 25 years ago, we defined health risks by weight and BMI, but that's changed recently. Can you talk about that? Definitely. I mean, BMI is a very outdated tool. And what is BMI? It's your body mass index, but it's a simple calculation between your height and your total body weight. I still use the term obesity. Yeah. And for many people, it's easy to understand in that language, right? But it's a simple calculation that was designed for the white European male in the 1800s. But if we cannot use it as a parameter of health, I think we can use it in a very broad population, right?

25:51But it cannot be specifically for somebody when they're a single person, when they're trying to improve their health. We should look at other parameters. Look, GLP-1 medications are sophisticated drugs. So for sophisticated drugs, we should have sophisticated ways of diagnosing somebody with obesity. Right. We know better now. This is not 20 years ago when we didn't know what we were looking at. Now we know. We know what matters in somebody's health, for longevity, for quality of life, for independence, movement, to decrease your risk of mortality, right? To decrease the risk of more than 50 cancers related with obesity, increase fertility.

26:34So how do you measure body composition? So there's several ways. The gold standard for body composition is an MRI, right? But MRI, well, it's expensive. Expensive. Expensive. You need to be in a radiology center to have all the logistics to have an MRI machine. The second best is a DEXA scan, but also expensive machine to have a doctor in their office. The third best is an impedance machine, which uses electrocurrent to separate fat, muscle and water. And that's what we use, what I have in my office.

27:09Dr. Mary Claire Haver:I have the same. So do you think these drugs are a game changer for midlife weight gain? They're a game changer for overall health. We will live longer because of the development of those medications. Okay. But which I have to say that GLP-1 was discovered by a woman, which I think it's important to mention because we don't hear their names, right? Right. It's Dr. Svetlana Mokchev, and she was in Harbor in Rockefeller Center here also in New York. And she's the one that discovered GLP-1 in the human body. So how should we think about GLP-1s in perimenopause and menopause? I think it's a great option, right, that we have.

27:50I think it's a great time to be a woman in midlife right now because of the availability of hormone therapy and GLP-1 medication, meaning no more accepting the less than 100 % feeling good or having a good quality of health. Right. There's no excuses. Right. We can talk about cost accessibility, but they are available. Right.

28:17Dr. Mary Claire Haver:What about in adolescents or younger patients? Do we have enough data? Yes. So they're actually approved. So liraglutide, which is piktosa, that's a medication, a GLP-1 that is a daily injection approved for type 2 diabetes, is approved for 10 years and older with type 2 diabetes. Saxenda, which is liraglutide for weight loss, branded for weight loss, is approved for 12 years and above. Wegovi, which is semaglutide, also approved for 12 years and above. So rapid weight loss, if we know if someone undergoes a gastric bypass or, you know, severe caloric restriction, the studies done on those patients show a lot of muscle loss.

28:57Dr. Mary Claire Haver:And this has become really a hot topic on social media. How do you counsel your patients to protect their lean mass or their muscle mass while they're being treated with the GLP-1? And this is something that even me at the beginning when I started prescribing these medications, I wasn't aware of this. So it makes me think all those patients that lost after bariatric surgery or that we were recommending eat less, restrict yourself and then coming and losing 10 pounds. And we were so proud and reassuring to the patient, great, you lost the weight. It was probably a lot of muscle, right? So we were doing more harm than better.

29:37Why?

29:38Dr. Mary Claire Haver:Why is losing muscle harmful? Muscle is our most important metabolic organ. It's actually an endocrine organ. It produces hormones called myokines. So muscle is anti-inflammatory. Muscle prevents insulin resistance, hyperinsulinemia, right? Metabolic syndrome. Muscle, when it contracts, it subtracts glucose or takes glucose from the blood and converts it to energy. Muscle burns fat for energy. So the more muscle you have, it's like your burning calorie machine, your burning fat machine, right? The more muscle you have, the higher your metabolism is. The less muscle you have, the lower your metabolism is, right?

30:22So muscle is a vital organ that we cannot talk about weight loss without talking about muscle.

30:30Dr. Mary Claire Haver:So in our clinic, we have an hour counseling visit for a new start, GLP-1. And that's, we've already started them on hormone therapy. If they're a good candidate, they're coming back for this discussion. And we take a whole hour to talk about ways to protect their lean mass while they're losing weight. How, what exact things do you counsel your patients about? Definitely. So is there a medication they can take to preserve muscle? Not yet. Not yet. We have to go back to the gym rack. So it's vital. And also I spend one hour with my patients in their initial visit because it's vital to explain to them that one part, one third of their treatment will be strength training and another third part of their treatment will be protein in their diet.

31:16And the other third will be a GLP-1.

31:19Dr. Mary Claire Haver:So that's your GPS. That's my GPS. So let the audience hear that again, because I think it's so important. Yeah. So if I could write it in a prescription, I would. It's the GPS. I call it like that. Wait a minute. Do you think we should be able to write that as a prescription? Yes, we should. It is. It is health. Do you think that insurance should cover personal trainers? 100%. All right, keep going. I like to call it the GPS, like navigation system, because going on a GLP-1, going into a weight loss journey, it's a journey, right? So it's a roadmap. So the GPS consists of GLP-1. Okay. The P is for protein in your diet.

31:54Protein.

31:55Dr. Mary Claire Haver:So GLP-1 protein. And the S is strength training. Strength training. Right. So that has to go, I tell my patients, the other two is as important as the GLP one. Okay. It's re-educating the patient. We as physicians, as healthcare, we are re-educating ourselves, but also we have to re-educate our patients of the concept of weight loss, right? So does it work? A hundred percent. So that idea or that headlines that you read, you're going to lose 30 % of muscle. Yes, you can lose 30 % of muscle and it will definitely happen if you don't do your GPS, right? So once a person decreases their caloric intake, we're decreasing our protein consumption, right?

32:37So that's why there is muscle loss. Rapid or significant weight loss is not free without muscle loss, right?

32:47Dr. Mary Claire Haver:What's an acceptable amount then? So what you're saying is, let me make sure I get this right. You, with any weight loss, you are going to lose muscle, right? How much is too much and what is your goal? So I recommend of what I've seen because I perform body compositions on every single patient on every single visit. So I know what the changes and what the changes that we're making in the patient's diet and the strengthening, what changes we're seeing in the body composition. Let's say a patient comes to me after eight weeks, they lost 10 pounds. If they lose one pound of muscle, meaning 10 % or less, it doesn't impact their fat loss, right?

33:25Their percentage body fat loss and their visceral fat. If they're losing more than that, I have patients that maybe they lost three pounds out of the 10 pounds or that's 30%, right? So that impacts or slows down the body fat loss. And why is that?

33:41Dr. Mary Claire Haver:Why would that be? Because you're losing your burning fat machine, right? Your basal metabolic rate is becoming even slower. So whenever they said, oh, when you lose a lot of weight, your metabolism becomes slower. Well, it's because of all the muscle loss that happened with it. So what I think most of our listeners don't understand is what is the basal metabolic rate? It's how many calories you burn at rest. Okay. And what is the one organ that determines that amount? Muscle. Muscle. Right. Muscle. So if I take all the muscle out of your leg, you know, 25 % of your muscle mass, then you are not going to burn as many calories at rest.

34:21Dr. Mary Claire Haver:We know from studies that patients who stop GLP-1s will regain about 70 % of the weight. So there's a big debate about that. And I have patients frightened. Am I going to be on this for the rest of my life? So we have to take a step back on this because the problem that we as a society, general society, and even healthcare, we need to stop viewing weight loss as something aesthetic, as something external. So if somebody is going into these medications thinking of something external, it does seem completely crazy to be on a drug long term for it, right? Right. You got there, you got to your size, you got where you look good, then why continue with this medication?

35:10The problem is how we are viewing weight loss.

35:13Dr. Mary Claire Haver:How should we be viewing weight loss? It's a medical problem. Obesity is a chronic disease that weight loss is a treatment. GLP-1s are a treatment for a chronic condition. And why do we understand by chronic conditions that they're not curable, right? They're chronic. They will require long-term treatment. Let's say somebody goes on blood pressure medication. They improve their blood pressure. Why do we say, oh, stop your blood pressure medication because now it's normal? Now, there are people who can stop their blood pressure medication. It will depend on the individual personal story that took them to the place of needing a medication, right?

35:51So if I have a 60-year-old patient that started struggling with their weight at eight years old, nine years old, that it's been a lifelong struggle, then most likely they will require the medication long term, right? And I always like to flip it and say it is not a bad thing because for the first time in history, we have something that is going to help not just with the weight loss, but maintaining the weight loss, right? Because any diet, any restriction, you will lose it. But to stay there is what becomes impossible. But now using a drug with the correct supervision, it can be used long term.

36:33It is safe to be used long term and it's designed to be used long term. I can give you the example, my example. I never struggled with weight. I got pregnant in my late 30s, had my first kids in my early 40s. I hit perimenopause. I gained 30 pounds. My A1C went up, right? I had two toddlers. I used semaglutide for six months and I was able to stay off of it. But I started training all my life and I didn't struggle with weight, right? So in those situations, there is a possibility, right? I always tell my patients, your biggest bet on not depending on this drug long-term is what happens to your muscle mass in the process.

37:13Dr. Mary Claire Haver:What about patients who come in wanting to use them for short-term reasons, like for an event, for a wedding, they're using them for cosmetic reasons? Well, again, they should not be used in that scenario, right? But I've learned to not to assume anything, right? And I don't know if this person is restrictive to maintain a weight and cannot get to a lower weight. So walk me through that. I've heard you talk about this before, and I think it's so important for our listeners. Someone comes in with a relatively healthy weight and they are asking about this medication. It's not an automatic no. It is not an automatic no.

37:54It's not an automatic yes.

37:55Dr. Mary Claire Haver:Because the internet will argue with you here. Even me that I've treated thousands of patients, when I see somebody externally, when they walk in my office, I cannot say what's their visceral fat, what's their percentage body fat, what's their muscle mass. They may look slim, but maybe it's because they have very low amount of muscle and high percentage body fat and high visceral fat, right? It's what we call skinny fat or sarcopenic obesity. So, but they come in, you do the body scan and everything kind of looks okay. Yeah. You're still saying no. No. And then I go walk me through your day to day.

38:31Right. Like, what is it that you eat? What is it that you exercise? And for many patients, it's a restrictive lifestyle to maintain that weight. What does restrictive lifestyle mean? Something that is not sustainable. Right. Something that is removing you from your daily life. Right. So somebody who is counting calories, who is weighing their food, somebody who is exercising seven days a week. Right. that they cannot enjoy the process, that it's a full-time job.

39:02Dr. Mary Claire Haver:To maintain that weight. And what do you see with those patients? That they may benefit from the medication, right? We can relieve them from that. And it's not just here's the drug, you don't have to wait, but then it becomes a re-education. Then you talk about muscle, building muscle, strength training. See, these patients may be cardio queens, right? They're doing spinning every day. They're running. They're doing all the cardio. Then you re-educate them on how to exercise. But once you remove that foot noise, that weight noise, then they can concentrate on exercising for health. So when you remove the pressure of weight loss to somebody who's exercising.

39:49Or maintaining your weight. Or maintaining your weight. It becomes enjoyable for many patients, right? It becomes more adaptable and easy to maintain long term because that's not the solution. That is not the solution for the weight loss. So to answer your question, it depends on the story. It depends how it's consuming their life. It depends on their body composition.

40:13Dr. Mary Claire Haver:So it is not FDA approved for outside of obesity, right? It's approved for weight loss and obesity. But in this situation, we don't have an FDA approval for this. But in your clinical experience, you feel... Yeah. So patients, when we're talking about the indications, currently it's indicated for a VMI greater than 27. So even on overweight patients, right? But see, we're treating numbers. Right. We're treating numbers. We're not treating the patient. And we have to meet patients where they are. And I've heard you said this before. We have to see where they are in their life, in their age, We ask too much from patients sometimes without getting their results.

40:57I don't think it's fair for us to gatekeep a medication that can be beneficial, not just physically, but mentally also on a patient. Now, I do say no to some patients. So if a patient comes to me and they tell me I want to lose weight, but their muscle mass is great, their percentage body fat is great, then I say no. You don't need the medication. What you're doing? You're reassuring, continue doing what you're doing. Because if somebody comes to me and their percentage body fat is low and their muscle mass is high, I already know that their lifestyle is healthy. Yeah. I already know what the nutrition is, right?

41:36I already know that they're working out. I can see their blood work is going to be good, right? Their blood pressure is good. So the parameters go with the body composition.

41:45Dr. Mary Claire Haver:That's my favorite visit is someone who's felt she was overweight or even obese her whole life and she's never had a body scan. And we get her on the scanner. And I'm look at this gorgeous muscle that you have. You have such little body fat. You have no visceral fat. You just have a few curves that your genetics and God gave you. Her labs look great. Her blood pressure is perfect. And she is so reassured because she has felt because of this BMI ridiculousness that she has had a weight problem her whole life. Yeah. And it's also teaching patients, and this is going to take time for generations, is to understand that their weight doesn't equal their health.

42:23The number and the scale is not telling us all the picture in there, right? It's your body composition.

42:31Dr. Mary Claire Haver:They're still hearing this from their clinicians and their doctors, that your weight is too high, your BMI is too high, even though the guidelines have changed. How long do you think it's going to take before everyone gets on board? I think it's going to take probably the new incoming generation of medical school students, right? So probably in the next five years, 10 years, I think it's going to be more broadly accepted.

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44:44Dr. Mary Claire Haver:From outdoor shades to room darkening blinds, finding the perfect fit is easy. Get free samples, expert design help, and professional measure and install services. Or DIY it with confidence and support every step of the way. Shop up to 45 % off site-wide right now during the 4th of July VIP access sale at blinds.com. I hear a lot on the internet about microdosing. What is that? And do you recommend it? So microdosing is when you use a micro amount, a smaller amount than the therapeutic doses. Microdosing is when somebody wants to use a smaller dose than the therapeutic dose to get benefits outside of weight loss, right?

45:27Because we know that to reach weight loss, you need the therapeutic doses. Now, the concept of micro dosing is by people. And this is what I've seen the most is that for the anti-inflammatory properties or am I missing out? Am I missing on the all healthy benefits of GLP-1 that people that are losing weight are getting?

45:46Dr. Mary Claire Haver:I see it all over the Internet. Every wellness influencer talks about micro dosing. But so there's two things in those scenarios. One, it could be somebody who has a perfect body composition, right? right, low percentage body fat, high muscle mass, low visceral fat, that I reassure them, you already are getting all the positive benefits that somebody is going to get from a GLP-1, right? You have muscle mass, you are burning calories with your muscle, you're strong, you have a low percentage body fat, you don't have visceral fat, so you have a very low risk of disease. There's nothing extra that you're going to get from a GLP-1.

46:27Now that's one side of it. The other side is somebody who thinks, who doesn't need to lose weight, right? I don't need to lose weight and I just want to use the medication, but surprise, surprise, when we put them on the machine of truth, I like to call that the body composition, then you realize they're under muscle, they have high visceral fat, they have high percentage body fat. So you don't need the microdose. You need the real therapeutic dose. So what is that causes inflammation in our body? Visceral fat is pro-inflammatory, right? And visceral fat increases insulin resistance, hyperinsulinemia, which also in itself is pro-inflammatory.

47:04And then many patients with obesity may have low muscle mass. So it's a triple whammy in inflammation, right? So when somebody goes on a GLP-1 and they start losing visceral fat, their inflammatory markers go down. And if they start building muscle, then their inflammatory markers go even lower, right? That's why we see improvement in autoimmune diseases, right? Because now the immune system can do its job, can protect the body. Less infections, less getting sick because of that effect. But what is it in the medication? One, that you're going to decrease eating, right? Your caloric intake is lower.

47:43Dr. Mary Claire Haver:And how would that lower inflammation? Because you're dropping visceral fat. Second, it's because the effect of this medication that it decreases, suppresses your hunger hormones and increases your satiety hormones. Satiety is when you're full. So these drugs increase your fullness hormones. So you feel fuller with half of what you normally would eat. And then it suppresses your hunger hormones in between meals. So patients eat half of what they normally eat without feeling hungry or craving in between meals. So by cutting us already immediately to one third to two thirds or half of what you normally would consume, you're also decreases pro-inflammatory food.

48:22This medication also suppresses their reward or blocks their reward from food. So what is the reward for food for many patients? Either starches, sweets, salt. Those are high reward foods? They can be high reward foods. OK. And that's pro-inflammatory food.

48:41Dr. Mary Claire Haver:Do you feel that part of the obesity epidemic, and do you feel it's an epidemic? Yes. Yeah, we know it is. Okay. Is due to the food industry? In big part, yes. The way that our food is made in this country is not the best for our health, right? We concentrate on quantity and not quality when it comes to food. I do feel like the food industry at one point, hopefully in the not too far away future, will be held accountable for the obesity epidemic that we have, right? Food accessibility, the good, healthy food tends to be more expensive than the none, right? And you cannot argue with a family of six that they're making it month by month on their paycheck to buy grass fed meat or organic fruit.

49:39Right. So food accessibility has to also change. But also our environment, right, where we live. We live in cities where walking is not promoted, is not encouraged anymore. You know, we take a car everywhere. So also now we can work from our living room. We live in an environment that exposes or makes us be sedentary. I've heard it called an obesogenic environment. Environment. Also, we can talk about endocrine disrupting chemicals in the obesogenic environment, right? Plastics, BPA, the forever chemicals, what's in our water, what's in the paint in our walls, right? So that also can promote obesity.

50:20Now, and when we talk about obesity, we can go even generations before us. And this is where we talk about removing the guilt for someone, right? And I can give you the example of an appointment that I had with a new patient. It was a 14-year-old girl that was brought by her mom and her dad. And they were bringing her for obesity. And I had both parents there. And I always want to know what's the family history. I go two generations behind. Did your parents struggle with obesity? In this case, she was a 14-year-old. Her parents were there. So I was able to talk directly to both parents. The father also struggled with obesity.

51:00The mother had PCOS. The father, his mother struggled with obesity and his maternal aunts also struggled with obesity. His brother struggled with obesity. So you can see three generations to my patient with obesity. So obesity is transgenerational. Yeah. There's even data. It's so interesting. There's even research showing that transgenerational trauma is a cause of obesity also.

51:32Dr. Mary Claire Haver:So there is a study I remember reading about in residency in OBGYN. And it was talking about imprinting of changing our genetics. And this was specifically on women who were in Germany. had, this is World War II, and they had occupied maybe Belgium or, you know, one of the European countries. And women who were pregnant during the occupation, they were severely calorically restricted because they didn't have access to food during the occupation. So they were just eating a few potatoes a day or whatever they could get their hands on. But malnutrition and starvation was huge during this occupation.

52:06Dr. Mary Claire Haver:They then go on to deliver their babies. Those babies were all born underweight, okay, which is normal when you don't feed a fetus, it doesn't grow. An overwhelming majority of those children who had non-obese parents grew up to be obese. And the thought process was we had changed their genetics while they were, you know, embryos and forming in the uterus from this severely restricted environment. Yeah. So transgenerational trauma is a cause of obesity, right? There's so many studies that children that go through trauma, even without having family history of obesity, tend to have obesity more than those that were not exposed to trauma in early childhood.

52:53So there's so many factors that if you put them all together, how many does a person with obesity actually have control of?

53:01Dr. Mary Claire Haver:And being told your whole life, this is your fault and you don't have willpower. I think that that's traumatic for patients as well. Very traumatic. Very traumatic. And that's the reason that also they don't trust, right? And they stop talking about it. But when I tell patients, even before you were born, you might already have the risk of having obesity. Because we know that genetics, and I'm talking about epigenetics, right? That there's multiple genes affecting that one single gene. So we know that both parents' weight at preconception will impact the weight of their offspring. Amazing. even 50 to 70 percent.

53:40Going back to my patient, the patient, the 14-year-old says to the dad, oh, so see, it's your fault that I develop obesity. And it was not to blame because his mom had obesity too, right? She didn't know. The father didn't know. But now we know, right? So this 14-year-old that we can treat now will break that cycle of transgenerational obesity. And this is something that I always have when I have my reproductive age patients that they tell me, oh, I want to get pregnant in six months and they have obesity or overweight. I explain to them, look, what your weight is and the father's weight. This is not just the mother.

54:21Both parents' weight is going to impact the weight of your children and your grandchildren. So with this information that we have, we can break that transgenerational obesity pattern.

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55:21But it also supports immune health, reduces inflammation, and has been linked to

55:26Dr. Mary Claire Haver:better mood regulation and cognitive function. The challenge? It's hard to get enough vitamin D from food alone. Fatty fish, egg yolks, and fortified dairy help, but sunlight is our biggest source. And depending on where you live, your skin tone, and how much time you spend indoors, that might not be enough. Most women benefit from supplementing with 1 ,000 to 2 ,000 international units per day of vitamin D3, which is the form your body absorbs best. I recommend getting your levels checked with a simple blood test and adjusting your dose under your clinician's guidance. Because when your vitamin D is optimized, your bones, muscles, immune system, and even your mood may thank you.

56:08Dr. Mary Claire Haver:And remember, always to consult a clinician before introducing any new nutritional supplement.

56:19Dr. Mary Claire Haver:You say in wait lists that some patients who are given GLP-1s are being set up to fail by being offered these medications? Well, unfortunately, everybody's prescribing those medications, right? I mean, I can prescribe chemo drugs. I don't because I'm going to create harm, right? But I could, but I don't. So GLP-1 medication should be seen as the same thing, right? It's a medical treatment for a chronic condition. They're not something superficial, external to make the patient happy. I mean, I've had neurologists, ophthalmologists asking me, how do I prescribe this? And I'm like, you just shouldn't.

57:05For now, I do think that every specialty gets a patient with obesity for whatever reason, or that they're seeing the patient form a complication from obesity. But before we do more harm than good by prescribing these medications, we have to educate ourselves in obesity. And every doctor who's going to prescribe or anybody who's going to prescribe this medication should have a body composition in their office. You need to do it responsibly. Yeah. Because otherwise we are creating more damage than health. You're making the patient maybe, yes, they lost 40 pounds, but they lost 20 of muscle, right?

57:42And their percentage body fat didn't drop that much. So yeah, outside they look like they improve, but you might have made them less healthy than they came in.

57:51Dr. Mary Claire Haver:73 % of Americans over the age of 20 have obesity or are overweight. That's 180 million people. Why? Again, because our knowledge of what caused obesity was not completely understood, right, as we know now. And even with the information that we have now, it's going to take several generations to make the changes. So even if today the food industry is stopped and changes the way that they produce food, it's going to take two generations, right? Three generations for us to see the impact. So that's why we're where we are, because food industry, industrialization, environment, right? Because of all of that is why we are in an epidemic as we are.

58:36Dr. Mary Claire Haver:Weight Watchers, Noom, telemedicine companies developed originally for hormone therapy are now shifting platforms and adding these medications. And now I've even seen new telemedicine platforms being developed. And now this is a prescription. You must be a licensed practitioner in a state in order to prescribe these. So you can't go to Walmart and pick it up, you know, for yourself. So these are all licensed clinicians. But how do you feel about this kind of wave of new options available to patients? Well, I think weight loss has always been a very lucrative market. It's a big business. Always, even before we had GLP-1 medication, right?

59:18So everybody's going to want a piece of the pie. My problem with that is if they're not doing the right supervision, if they're not doing the GPS, we know that they're going to lose muscle. we know that that increases the risk for metabolic disease. So it's, again, we cannot just concentrate on the number and the scale, on making the patient happy, on seeing a number drop or a BMI. So if they're doing body recomposition, explaining the patients, have a body composition, doing DEXA scans, the more the merrier, right? Because I'm only one. People that are experienced, that have expertise are very few.

59:55And that's the reason that I wrote my book, because this is growing so fast. It's faster than what doctors are being trained off. So with my book, I want to have more people educated in the subject, right? Even maybe faster than what doctors are being educated.

1:00:12Dr. Mary Claire Haver:We've all heard horror stories of side effects, especially the viral ones on social media. But let's break it down. What are the big side effects? How do you counsel your patients? And how common are they? We like to talk about the bad things and we never talk about the good things, right? I even made a video where it says, oh, you've heard of osempec face, but have you heard of osempec liver and showing an improvement in the liver function test or the osempec pancreas, less insulin resistance, right? Because there's more good than bad with these medications. And whenever a drug is FDA approved or whenever I prescribe a drug is because I know the benefits outweigh the risks.

1:00:50Now, if it's in the right hands, we're going to have very minimal side effects. Okay. If it's in the wrong hands, somebody who doesn't know how this drug works, they don't know how to guide the patient, right? Then that's where we see this crazy side effects that we're hearing in the headlines, right? So what are the side effects? So these medications work by slowing your gastric emptying, right? That's how you stay fuller. That's your stomach. So normally when we eat, it goes through the stomach, it gets digested with the enzymes, and then it goes through your bowels. And then it's like a 24-hour process from when it comes in, absorb the nutrients and then dispose of what's not needed.

1:01:30This medication is going to be a slower process, right? And that's how you stay fuller also for longer periods of time. So what I've seen that I've had patients come that they develop some abdominal obstruction or bowel obstruction.

1:01:47Dr. Mary Claire Haver:What is abdominal obstruction or bowel obstruction? The bowel obstruction is when there's no passage of the nutrients not needed or of stool, right? And it gets impacted and you can start vomiting, having pain. So it's very serious. So how often should these patients be seeing a clinician while they're on these medications? Ideally, every six to eight weeks at the beginning, right? Once you understand, once the patient understands the importance of protein in their diet, once you see they're not losing muscle, once you see they're tolerating the medication without side effects, you should see them every six to eight weeks.

1:02:25Once they're like halfway in the treatment, you can see them every three months, right? But always available to answer any questions and teach your patients what things to look for. But in reality, you don't have to change the dose before every three months. Okay. So that's another thing, right? So going up every month on the medication is not the recommended management of these medications, right? Especially with our newer drugs like tersepatide. I have patients have lost 30 pounds even on the 2.5 or the initial dose.

1:02:57Dr. Mary Claire Haver:So some of the patients never need to increase the dose. Some patients never go to higher doses. So we talked about the gastrointestinal side effects. I've seen reports on the internet of thyroid cancers and Mark Hyman was discussing like a laundry list of potential complications, pancreatitis. and all this stuff. How frequent are these? Are these just case reports? I can tell you I've been prescribing GLP-1s for close to 10, 12 years. Okay. And I've never had any of those complications on my patient. What is the most common complication? Nausea, especially, but more with semaglutide, which is Osempic and Wicobi.

1:03:33I don't even mention it anymore with Monjara and Seban, which is tersepatide. Diarrhea, but diarrhea can happen with any of the drugs of any of the generation of GLP-1s. Usually, and this happens with any fatty food or fried food, they don't break the fat as easy and they may have diarrhea. Dehydration, because normally our thirst is connected with hunger. So they need to proactively be hydrating themselves. How much water? What are we looking at? So I like to say one and a half to two liters. They should be peeing every three hours. Yeah. What about our menopausal mama who's getting up and peeing at night?

1:04:10Well, the day I tell them three hours before you go to sleep, you stop drinking water. So load your water during that first half day, the two thirds of the day, and then wind down. And this is for everybody so they don't wake up.

1:04:26Dr. Mary Claire Haver:Where to find Dr. Rocio Salas-Waylan. As a reminder to our audience, your book, Waitlist, is out in December and available for pre-order right now. Listeners can also find you on Instagram at Dr. Salas-Waylan. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get the honest, accurate information on health, fitness, and navigating midlife at thepawselife.com. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love.

1:05:04Dr. Mary Claire Haver:We would be so grateful. You can also find full episodes on YouTube. Unpaused is presented by Odyssey in collaboration with Pod People. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on Unpaused are those of the talent and guests alone. They are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. Your call has been forwarded to voicemail.

1:06:02Dr. Mary Claire Haver:Only on Netflix.