Weight Regain After GLP1s & Why It's Expected | Solo

On this episode of The Dr. Tina Show, we are going to be jumping in to this latest scientific publication that has come out recently. It's all about the weight regain after GLP-1s. It came out in the British Medical Journal very recently. The internet is all ablaze. Everybody is having a field day, of course. And we got to cover this, even though I'm fairly done talking about this GLP-1 conversation for a hot minute. I need a break. But this pulled me back in because this is a perfect example of people being intentionally ignorant. And we need to talk about it. It's a big game of no shit, Sherlock, basically. So without further ado, let's jump in. You are tuned into the Dr. Tina Show with Dr. Tina Moore. For more, visit drtina.com. The article is titled, Weight Regain After Cessation of Medication for Weight Loss Management. It's a systemic review and a meta-analysis. They basically took a bunch of studies going way, way back of all the different types of GLP-1 medications, the different incretin medications, and looked at overall what were the outcomes. And the results were this paper. So the 922 titles screened, 37 studies, 63 intervention arms, 9,341 participants were included. Average treatment duration was 39 weeks. The average follow-up was 32 weeks. The average monthly rate of weight regain we're going to talk about. There was a lot of weight regain. And I want to preface this with some understanding, some definitions, and also some just very basic common sense. What happens when you don't do anything else but take blood pressure medication for your high blood pressure? Drum roll, please. Your blood pressure skyrockets when you go off the medication. What happens when you go on a statin medication for high cholesterol and you don't do anything to change your high cholesterol levels? Your cholesterol and lipids skyrocket when you go off the medication. This is the no shit Sherlock game, right? So if an individual goes on a medication to treat a chronic illness, what are the expectations when they go off that medication? Because there is no pharmaceutical that actually cures anything, right? They're all Band-Aids. There's been no, I have had, my conversation about GLP-1s and microdoses and the healing impacts and all of that, yes, that all still stands. That's not the conversation we're having today because that conversation got twisted up and people took it for what they wanted. And big, big FYI, 99% of you are not microdosing. You think you're microdosing. You're not. The standard starting dose for semaglutide is 0.25 milligrams. Most of you are started on 0.25 milligrams and told you're microdosed. The standard starting dose for trizepatide is 2.5 milligrams. Many of you are put on that dose and told it is a microdose. It is not. Both of those are the standard starting dose. They're both the doses that are given to people with extreme obesity and extreme diabetes. You're not microdosing by taking the standard starting dose, okay? A microdose is a fifth to a tenth of the standard starting dose. It is not a weight loss strategy. It was never intended to be a weight loss strategy. It is not a vanity weight loss strategy. You guys have lost the plot. And I've done a whole podcast about that, so I'm not going to rant. But continuing on in this game of no shit, Sherlock, when you have a chronic illness or chronic disease process going on, and you don't take any lifestyle measures to remedy that chronic situation, then when you go off the medication that you're taking for that chronic situation, the chronicity of the situation returns. That's just how it works. So there was never any illusion that taking a GLP-1 would magically allow you to lose weight and forever keep it off once you stop the medication. That has never been the case. And yet people love to double down on that. Well, when you go off it, you gain all the weight back. Yes, no shit, Sherlock, right? Same thing with all the other medications. And I can make a very strong argument that your high blood pressure and your need for high blood pressure medications is coming from lifestyle. Almost 100%. I would say 90% of lipid issues are coming from lifestyle. There is a hereditary issue there. There might be a hereditary issue with high blood pressure, but I don't think it's necessarily the high blood pressure as much as it is your cortisol response to things. And what is really high blood pressure anyway? I did a whole podcast about it, but that number keeps changing. So for the sake of simplicity and the sake of just all of us agreeing, I think we can all agree that most of these conditions, including type 2 diabetes, are lifestyle first. And if you don't change the lifestyle factors, the medication being removed from the scene will allow that disease process to return. So that's just basic physiology. That's just how it goes, right? Now, we could argue all day about lifestyle and how much of it is to blame. I will say this. I recently saw a big influencer who I respect him. He did a post that said, it was kind of like a new year, things we can all agree on in the new year. And number one, obesity is not genetic. This guy's smart. He doesn't actually have any clinical experience, nor does he have any nutritional training. He's just sort of a self-learned guy, which I'm not dissing. A lot of you are self-learned and you're here. And this is why I teach because you guys are self-learned and you are smart as hell. So that's fine. But it was such an ignorant thing to say because it's wrong. And there are genetic components and there are epigenetic components. And this is not a podcast episode about the nuance of the disease of obesity. We can do that another day. I talked to Dr. Spencer Nadolsky. We can put that in the show notes. He goes into it a bit. But here's the thing. Those genes, those epigenetic influences, those are all turned on or off by your lifestyle. So while there are definitely genetic propensities towards obesity, those genes act more strongly, if you will, in the presence of high refined carbohydrate intake, lack of exercise, all the things, right? So you can turn the ship to a large degree through lifestyle when it comes to obesity. That doesn't mean that obesity is not a disease. That does not mean that obesity does not have genetic components and epigenetic components. It's nuanced, it's both, all right? So just like your high blood pressure, just like your high lipids, It's both. And so we have a saying, which I probably will get in trouble if this is on YouTube. So I will say pew pew, but genetics loads the pew pew and environment and lifestyle pull the trigger. So that's how it works. I'm not gonna argue with you guys. I'm sure you'll have a heyday in the comment section, but that's how it works. I'm sorry. And those of you who are arguing otherwise are intentionally ignorant and not looking into the latest data or you have severe obesity bias. And if you're mad at me, then I don't care because in 2026, I do not give a shit about anything. I am out of shits to give. So I'll quit cursing now, but we'll move on. So this paper basically showed across all of those studies that they did the meta-analysis on and the systemic review that there was a very large weight gain return. And all of the markers that had improved, the blood markers, The hemoglobin A1c and many of the markers that they ran that had shown great improvements on the GLP-1 all ceased to be improved once the GLP-1 was removed. The GLP-1 was doing the heavy lifting. You guys know I have argued against high doses of GLP-1s. I'm not a fan. I'm not a fan under any circumstance. Microdosing was what I came out with. And I told you all from the beginning that it is reserved for those who are metabolically optimized already. This is not obesity bias. This is just facts. You can't use tiny doses and expect a damn thing to happen unless you're already in pretty good shape, pretty good health overall. And I did not make the rules. The need to crank the dose up to move the needle definitely comes with risks and it definitely comes with side effects and it definitely comes with an increased risk for gastrointestinal issues. I've been very transparent about all of that. I think my message was misunderstood by a lot of people because they just heard what they wanted to hear. And I can tell that because people will message me and say, I just listened to this episode of you on so-and-so's podcast. And then they give me their entire health history. And it's severe and chronic. And they're really sick. And they've got a lot of weight to lose. And they're like, will microdosing help me? No, no, no, no, no, no. You're looking at a more standard dosing necessity. That said, when we start taking super physiologic doses of something, one or two of these signaling peptide hormones, we mess up the orchestra. It's an orchestra. It's not just GLP-1. It's GIP. It's glucagon. It's ghrelin. It's leptin. It's CCK. It's PYY. It's all of these other, there's more. It's adiponectin. They all work harmoniously inside our bodies. And what happens when systems go awry and we end up going down that obesogenic diabetic pathway, that metabolic dysfunctional pathway, which by the way, is actually all derived. It starts in the gut. It starts with lipopolysaccharides in the gut. It all starts with the gut. I'll be honest. I didn't always think about what was in my protein powder. I just cared about the macros. 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We will probably repeat that sometime in the future because it was such a big hit, but it all starts in the gut. And so once that process starts and that person is on that pathway, then now we have to take into consideration those genetic and epigenetic factors and boom, we have a perfect storm. And I know many of you have messaged me and said, I don't know what happened. I hit menopause and I think I just blew up, like things just blew up. Like my health went sideways. My weight gain was massive. All the things, right? So if you're one of those people that want to shame that situation, then you should probably leave my following completely because I'm just not having it. It's just ignorance. And if you're a big influencer or even a doctor, God forbid you're a doctor and you think that way. Go look some shit up and learn better. Just go. Go do better because that kind of ignorance is, there's so many factors. I will come back to the hill I will die on though, which is your lifestyle turns those genes on or off or impacts how significantly they are expressed. So there's no just cranking GLP-1s and saying, okay, great. And there's no, let's just tell them to double down and eat less and work out more. That's what everybody screams in my comment sections and in my DMs. It's both. We have to figure out how to get that orchestra of signaling peptide hormones in their body under control to some degree. And they have to, as I've spoken of, the spark. We need that strength training, that exercise, that circadian rhythm, that stress reduction, the eating nutrient-dense foods, the movement, the sleep piece, the hormones, all the things, all the things, as I call it, those all have to be dialed in too. And they have to be addressed too, because a GLP-1 alone isn't going to fix it or an incretin medication. I don't care how fancy they get. It's not going to fix the problem. And this is not always going to keep the problem at bay, because here's what happens physiologically. I did a whole episode about this too. When you lose weight, you lose your leptin. Your leptin comes from your fat, and it tells your brain that you're full. And when you lose fat, you lose leptin. And so it is almost impossible for people who lose a tremendous amount of weight to keep it off. They have about a two, some studies say 2% to 5%, others say up to 10% chance of keeping that weight off. Those are the same stats as rehab. So it's like asking a heroin addict to kick the habit through better willpower. Right? So I know apples to oranges, but you get my drift here. They fighting an uphill physiologic battle And then the simplest way I can explain it is if they were running two miles a day to keep their weight at bay they now have to run three or four because of the reset That body wants to reset itself That metabolic rate wants to reset itself GLP protect against that to some degree, but there's no version of this where somebody takes a dose of a GLP-1, whether it's tiny or large, drops a significant amount of weight. And I would say a significant amount of weight would be 15, 20, 25 pounds plus, okay? Drops that weight and then keeps it off when they go off the GLP-1. And there's no version where it's just grind it out and it will always work. Now it might work for some, but I have grown up in an obese family. I have watched everybody I love in my family go up and down and up and down and up and down in their weight. I'm the only one who's really maintained a pretty consistent size and that has been very intentional and it is an uphill battle. And the older I get, the harder it gets. But that's just not how physiology works. So we'll go into that another day on a different episode. Let's talk about the study a bit more. And I have a solution for you. So hopefully that was helpful. I do want to mention that we've got a few players again to keep in mind as I go through this. So we've got other signaling peptide hormones that play on appetite. They play on meal timing. They play on when you are done eating. They play on, are you full? Are you getting full? It's all an orchestra and there's different players that are secreted from different parts of our body, our gut, our brain, our fat, you name it. And so this is a very complicated orchestra and it's like asking a very high level jazz band to like forego their drummer or something. Or we could look at GLP-1 as just the bass drum, right? It's a big, heavy, that's a hammer when it comes to a band. So the bass, if the drummer starts hammering the bass drum, everyone's going to hear it more so than the guitar player maybe plucking an incorrect string. So think of GLP-1 as like the big hammer, but you can't just keep hammering. And I have warned against this, and this is why I'm not a huge fan of the high doses is when you, especially if the person's not really doing all the things, because what happens then is we have somebody who comes in already very metabolically compromised, right? They're very metabolically busted. By the time they get to type 2 diabetes, they are extremely metabolically busted. And I'm talking severe mitochondrial dysfunction at that point, severe lipopolysaccharide production in the gut, which means the gut is usually way whacked out, which means the liver's whacked out and the pancreas is whacked out and the gallbladder's whacked out. The whole system is already in severe chaos by the time we get to type 2 diabetes. That's been going on 10, 20 years. Now that person takes a dose of GLP-1, gets escalated very quickly, ramps it up very quickly, and they don't do anything to protect their muscle. They don't eat nutritionally dense food. They don't prioritize their strength, their muscle. Maybe their sleep gets disrupted because GLP-1s can definitely induce insomnia. and maybe their heart rate variability gets a bit whacked out because that can happen too. And I think the higher the dose, the higher the risk on all these things. And they start to have gut motility issues. Here's the crazy part, and I'll do a whole podcast episode about this, or I'm thinking about doing a masterclass, actually. This is the big one, guys. When you take enough GLP-1 to start to slow down your gut motility, which even a microdose can do, and you don't take care of your gut health, and this is why I had a course and why the course was so beefy because I had to cover a lot of this information. If you don't take good care of that gut motility and that gut health, and I think the best way to do that is through exercise. So those of you on a GLP-1 who are not exercising, I am so sorry, but you are potentially so screwed at the end of this. If that gut motility stalls, you have a very high risk for something called SIBO, which is small intestinal bacterial overgrowth. And we have data showing that like up to 45, 50% of people on GLP-1s experience SIBO. Guess what SIBO is? SIBO is when you end up with pathologic organisms in your gut. Your gut's not moving. Your small intestine isn't moving. The bugs that belong in the large intestine that aren't supposed to be in the small intestine end up in the small intestine because gut motility is not going that way. It's kind of creeping back this way because everything's stalled out. This happens in people who are not on GLP-1s. I went into microdosing GLP-1s and this is why we cycle them. I went into them with SIBO. So I have to be very careful when I'm on them. They can aggravate me. They can aggravate my SIBO. You have massive bouts of stress. Stress will completely stall out your gut and obliterate your microbiome like that. And so you've got someone who's really stressed out. They're not taking care of everything else. They're not, and let's just throw in hormones for good measure. I mean, once estrogen starts leaving the building and progesterone's off, we start to get significant changes in our gut health, our gut motility, our liver health, our pancreatic health. Like all of those are dependent on good hormonal milieu. And now we add in a whopping dose of GLP-1. And now we've got SIBO. And guess what SIBO is, guys? SIBO ends up with much higher levels of lipopolysaccharides. Guess what lipopolysaccharides do? Induced diabetes and chronic pain and brain fog and Alzheimer's and all kinds of things. And so I'm not saying the GLP-1 is doing this. I'm saying SIBO, which is very common. And I would say that, I mean, I joke with my colleagues when my colleagues, I think it was Kyle from Level Up was on my pod recently. And he said, how many people do you think have leaky gut? And I was like, everyone. I mean, I have never tested a gut that wasn't, I've never seen a patient come in who didn't have some gastrointestinal issues, whether it's the top end or the bottom end. They're either running out the bottom end or they're more likely not pooping at all. I mean, giving a GLP-1 to someone who's not pooping every day is just crazy, crazy to me. But anyway, I understand y'all got to do what you got to do. And keep in mind that most doctors have about seven minutes in the room with you before they're losing money. So, and that was back in the 90s that started. So, I mean, we're in a mess. I'm not trying to upset anyone. I'm just being honest with you guys, which I know you don't all love. And I know some of you love me for it and some of you hate me for it. but this is just the come to Jesus talk. This is what we're doing here. So if we're making SIBO worse and we're elevating levels of lipopolysaccharide in the system, then we are inducing a more severe metabolic dysfunction overall. So it is severely ironic and terrible that high doses of GLP-1s induce SIBO in virtually half of the people who take them. And I'll put the link in the show notes for you to look at the study. There's a few of them I found, but this is just where we're at, okay? So this is why I was so adamant and beating that drum and taking all the hits for it because I was like, you guys, we got to bring this dose down and we got to figure out how to do it. And it is a lot of lifestyle. So there's just one tool in the toolbox. All right, you know I'm all about mitochondria, circadian rhythm, and getting to the real root cause. And I'm going to tell you something that most people are missing. You don't likely have as much of a health problem as you think. You more likely have a light problem. I'm literally uprooting my entire life and moving to Arizona because I'm so light deprived in Oregon. You know, you're eating clean, you're working out, you're taking your supplements, but you're still tired, you can't sleep and your hormones are off. Why? Because you're living under the wrong light. Screens all day, LEDs at night, your body has no idea what time it is and it's wrecking your cortisol, melatonin and your entire hormonal cascade. That's why I wear Viva Ray circadian glasses because the science is solid and they work with your biology. Daytime lenses during the day balance harsh blue lights, but keep what you need for energy. Evening orange lenses after sunset signals wind down and red lenses before bed protects melatonin. If you use prescription or reading lenses, they've got UV transmitting lenses, the only ones that let natural UV through, which you need for circadian and hormonal health. Fix your light, fix your biology. It's that simple. Go to vivarays.com and use code DrTina at checkout. Anyway, according to the study, people on average regain at a rate of 0.4 kilograms per month after cessation of the weight loss medications, leading to a projected return of baseline weight after 1.7 years. Keep in mind, this was like the mean. So they looked at all these people in all these studies, and there were some that were like on the low end and some that were on the high end, and they had to come up with a mean to report the data. Although weight loss resulted in improvements in hemoglobin A1C, fasting glucose, total cholesterol, triglycerides, systolic and diastolic blood pressure, all markers returned to baseline within 1.4 years of treatment cessation. The rate of weight gain after the cessation of the weight loss medications was faster than after the cessation of lifestyle, basically. So they looked at two things here. There were 37 studies, 63 intervention arms, 9,441 adults with overweight or obesity. The drug drains from the older agents to the new dual incretins all the way up to Tersapetide. Keep in mind, retitrutide is not FDA approved, guys. If you're getting retitrutide, it's not FDA approved yet. And you're probably getting it from a research lab. So I'm not going to talk on that until we have it. The average regain, like I said, was 0.4 kilograms per month. return to baseline 1.7 years. For the newer medications, the newer semaglutide and terzepatide, there was a faster regain of 0.8 kilograms per month and a return to baseline in 1.5 years instead of 1.7. They are stronger and more potent. They induce a more severe weight loss. So of course, when we go off them, there's going to be a rebound. After stopping medications, the following reverted towards baseline. Like I said, all of those blood markers and most markers returned to baseline within 12 months, hemoglobin A1C and diastolic blood pressure in 1.4 years. So that select trial that I referenced a lot, which was on the cardiovascular benefits, I would assume based on all of this, that that medication needs to be continued to continue to have those benefits. Now, somebody said last night on this, I was on a microbiome gut health masterclass that I hosted. And I'm going to be hosting a lot more of these throughout the year. So if you're not on my email list, go to my website and get on my email list. And anytime you opt in for anything, like there's an Assess Your Metabolic Health freebie on the front page of my website. If you head to the Contact Us page, you can join my email list. It's at drtina.com. It's pretty simple. Anytime you grab anything from me, you're on my email list and you'll be getting invitations to these masterclasses throughout the year. But I've got so many cool friends in my world and I just want to bring them on. I want to do more stuff with my friends this year. So this is how I'm going to do it. I want to, you know, I have these amazing conversations with these people and I'm like, I got to get these people in front of my audience because you guys need to see this too. And it's not just through the podcast. Like I love the podcast, but masterclasses are different, right? You're on live. We're all there together. It's fun. It's like a little party. So anywho, we were talking and it just became very apparent in the chat that people like didn't get the microdosing thing. They kind of made up their own versions, which I've already covered. And that there's a lot of different opinions about gut health. And there's a lot of different opinions about health overall. And I could just see it in the chat, you know. And so that's why I wanted to come on here and talk about all of this. Because I thought, you know, I got to cover that study. I got to talk about this gut thing with the GLP-1s. I got to talk about, I got to clear up the microdosing thing because it's just all over the place. And I'm sure you guys are confused and I get it. I can imagine how confusing everything is out there navigating all of this. The peptides, the gray market, the influencer selling you stuff. I mean, you guys are injecting stuff that some fitness influencer with zero credentials told you to put in you. It's like mind boggling to me. So we just need to be careful. And I know doctors can also suck. Like I get it. That's why I became a doctor because every doctor I ran into for the most part, I was a very sick little kid. I grew up in the medical system and I'm like, these guys suck. Like some of them have been amazing and I have loved so many of the doctors I've run into. But man, for the majority, it's like the mediocre middle, you know? And I won't go in a hospital unless I'm dying at this point. And I won't let anyone I love enter a hospital without me there as an advocate because it's just crazy what's going on. And it's not even the doctor's fault. There's so many bright young minds in medicine, but the system's so busted and corrupt that nobody wants to do it anymore. And insurance is a complete scam, in my opinion. So, you know, we got some things here. But anyway, they looked at lifestyle versus just the medication. And no, it wasn't perfect because it was a meta-analysis. It wasn't like a perfectly controlled study where it wasn't a study ran the way. I would love to run a study on GLP-1s, but Big Pharma hates me. so. So there was the weight loss medications, and then there's behavioral weight management programs. And what they found was that the people on the medications had a 0.4 kilogram per month regain. And the people doing the behavioral weight management programs had a 0.1 kilogram per month weight regain, which means the people doing the lifestyle did better than the people doing just the medications. So this drives home my point. You got to do all the things, right? And then the return to baseline was very interesting. It was 1.7 years for those on just the medications and it was 3.9 years for those doing the behavioral weight management programs. It still goes to show though that even with the best of intentions, even with all the best weight behavioral, I'm sorry, behavioral weight management programs, people still regain. Because like I said, weight loss, sustained weight loss is, it's a slim group that actually keep it off. And I know you see them on social media. So you think, oh, they've got it figured out. You'd be shocked how many people are in GLP-1s. You'd be shocked how many influencers have reached out to me in the past few years and said, I don't want to tell anyone that I'm microdosing. And then I find out they're not microdosing. They're actually just standard dosing, but somebody told them that it was a microdose. And they're now skin and bones. And they're so thin. And they're selling you programs for weight. It's ironic. But here we are. They're doing it for inflammation, right? I mean, I'm not dissing anyone. I actually got too thin when I first started microdosing and I was like, oh, that's too high. I was nowhere near even half the standard starting dose and it was too high. And I'm not, it's different. Whatever your dose is, your dose is. I'm not saying what you should or shouldn't do. I'm not laying any shame. But you can, a little bit too much, as I've said, of a GLP-1 can be a lot too much. And that goes for anybody of any size or any amount of weight to lose. And I think that that needs to be discussed because I went from feeling great improvements in brain fog and in inflammation and in pain to suddenly my daughter was like mom you too thin And I was like whoa you right And so I don take enough to suppress my appetite I don propose anyone else does if they're trying to microdose. Anyway, I'm going off on a tangent. What behavioral support did not do, it's more behavioral support during the medication treatment did not result in more weight loss, but no meaningful slowing of regain once the drugs were stopped. and behavioral support after stopping the medications did not change regain rates either. So very interesting. Behavioral changes matter, but medication is potent. The medication moves the needle quite significantly. And I believe you have to do both, but I never would say to somebody who was on a GLP-1 medication who had lost substantial weight or had substantial weight to lose, that they should just, oh, don't worry about the behavioral modifications or the lifestyle stuff. I would also never assume to say, once you hit your optimal weight, then just the lifestyle will keep you there. I don't think it will. And so you guys have heard me on a lot of podcasts, other people's podcasts, and they always want to argue the weight loss conversation. And that was never what I went there for. I was never went there to be the great defender of Ozempic. Like that was never my intention. and I went there to talk about the impacts of these on longevity in the metabolically optimized individual, which I realize not a lot of people are. And it would always get twisted into some big defensive thing like you have to defend it for weight loss and what do you think about this and what do you think about children taking it and just crazy questions that were so irrelevant to the point I was trying to make. And I never once said, sure, go ahead and take it and don't do all the things. I always, like my whole platform is built on strength training and eating enough protein. Like I've been talking about this as long as some of the big experts you follow longer than most of them have been online. I've been beating this drum. So it's really important that we understand that. But also GLP-1s heal. They are regenerative to some degree, but they can only do so much. And so in a busted system especially, right? And that's the point I wanted to get back to is I was on that master class and somebody said, Dr. Tina, you said they heal. And I was like, but they don't heal a freaking three alarm fire, right? They're not going to regenerate something that is still having lighter fluid poured on the top of it. That's the point we have to understand is we only have tools. I mean, certain supplements are healing and somewhat regenerative potentially. They activate certain pathways that are regenerative. But that doesn't mean that you can continue with your three alarm fire life. And it doesn't mean that if you go just a little bit too high, you might not aggravate some other systems. And so it's a fine line and it's a dance. And that's why you have to have a doctor helping you. I really do not think it's okay to be taking these under the guidance of a strength coach. that I, you can be mad all you want, but like, I have seen too many things go wrong. I have heard too many things going wrong. I get messages all the time from people of things going wrong. And I'm like, well, what the heck are you doing? When I find out, I'm like, oh my God. And then I get messages from my friends who were playing with things and they're, they're messaging me about their friends, of course, because whenever there's an emergency, oh, I have Tina on speed dial. So And then I'm like, are you asking me for you? Are you asking me for, oh, it's for a friend. They did this. And I'm like, holy smokes. So we got to, doctors do better, right? The doctors got to do better and learn about these things. And that's why I had the course. And the patients need to find people they can work with. And I don't know a better answer, but be careful. So what this study does not say, it does not say that GLP-1s are bad. and it doesn't say that weight regain is inevitable for everyone. Remember, it was the mean they were looking at and that long-term use, what are my thoughts? Personally, I think these should be cycled, but they really can only be cycled easily if we keep the dose on the lower end. It's really hard to take somebody who's on max dose off, just cold turkey. I think we need to titrate. We need to titrate up. We need to titrate down. If you go too slow though and you are looking for weight loss. That's why, here's the other part about microdosing. A lot of people thought they were microdosing and they thought it was a weight loss strategy. And so they stayed on the microdose forever or they stayed on that standard starting dose thinking it was a microdose forever. And then all of a sudden there's no weight loss and they're many months in and there's no weight loss. And now we have to crank the peptide up because they acclimated to it. There's all different versions of this not working great. And so this is why I had a 40-hour course that I have since pulled down because this is detailed and nuanced, right? You got to work with a doc who's willing to work with you. Please, please. And if you don't have one, keep searching them out. If you don't have access to somebody who can help you, keep looking for someone who can help you because they're out there. They might be online. They might be telemedicine or they might be a few towns away, but keep looking. And it's really up to you. It's truly up to the patient to be their own best advocate. It's always been that way. It's been that way since I was a kid. I was a sick, sick little kid. And I really had to double down when I became a young adult and find the people to work with who were going to help me and not just hustle me around and medicate me. So if they're not explaining things to you or they don't know it, go find someone who does. It doesn't mean they're a bad doctor. It means it's just not their wheelhouse. And they don't have any interest in having it be their wheelhouse. So again, I think both. I think both are very powerful tools. Complete lifestyle overhaul, medications that we can use thoughtfully and artfully. And in concert, peptides don't work alone. GLP-1s alone, monotherapy, I've said that from the beginning is not the solution. So we need things that signal a multitude of these signaling peptide hormones or sparks them, gets them to work. So anyway, there's limitations to the studies. There's limited long-term follow-up for the newer GLP ones. Most of the post-cessation data was capped at 12 months. So we don't know past that. The weight regain was modeled linearly, which may oversimplify physiology because physiology is really not linear. It's multifactorial, as I'm trying to explain. And then few trials rated as low-risk bias, meaning there might be some bias in there. The most important interpretation, I think, is that we understand that and what I hope this podcast episode is done for you, because I do have something I want to share with you that I think might be helpful. You cannot bypass physiology and expect great things to happen. You can't force aggressive, fast weight loss and expect great things to happen. You can't disregard the physiology of rebound weight gain. You just can't. If you are somebody in the field who helps people lose weight and you don't understand this whole regain concept and metabolic adaptation and how that works, please go learn it because that is real. There are a lot of coaches out there who can promise to get the weight off of you and these medications show promise in getting the weight off of you. But nobody knows what to do long term for these folks. It's like the biggest loser, right? That study showed tremendous disruption and damage to the metabolic system because of the severity of the weight loss and how fast it was. And looking at that data, it's very clear. You cannot slam a body into a wall of weight loss and expect great things to happen six months, nine months, 12 months, two years, four years down the line. Most of those people regain all the weight and very few keep it off. And the ones who do keep it off now are utilizing GLP-1s to help them. So there's a sweet spot and there's really artfully done GLP-1 use. And I know that there's lots of doctors out there doing it. So find them, keep looking until you find them because there's dosages to move the needle and then there's dosages to maintain the weight loss. And then there's titrations off and then there's cycling if we want to do them. I'm a big fan of cycling because I think your gut needs a reset. I really do. I don't think staying on these things long-term are an awesome idea, but do understand that people who are struggling with the disease of obesity, and I hope I made that point well in the beginning, and if you don't buy it, then that's fine, but it's real, and I didn't used to buy it either. I shamefully admit that I didn't believe it was a disease. It is a disease process. It's both. I have seen people who have the strictest diets who have the most disciplined lifestyle, the most disciplined workout schedule, doing exercise correctly, not even just burning up energy, but like really strategically working with strength and conditioning coaches and programming and strength gain, etc. And they still can't get the weight loss to happen. It's just, they just stall out at a point at some level where their body wants to be set at. And then I started experiencing that frustration of that weight reset with perimenopause as I'm heading into menopause. I believe it now. And I have admitted this before. I shamefully didn't understand the concept of obesity as a disease. And I have made it a point to study it as much as I can with the free time that I have so that I understand it better. And I'm telling you, there is a whole laundry list of genes. And I promise to get obesity doctors on here at some point. I've been waiting until we got the podcast studio built out so that I could have them in here live. And I brought Dr. Spencer Nodalski on, who is a weight loss, I'm sorry, obesity specialist. And we did a great episode together that I hope you guys will listen to. We kind of stayed surface level so that people could understand it and hang on it or hang their hats on it. But it's so complicated and nuanced. And people are being so, it's so gross. People I respect too, just saying the dumbest shit. And I'm like, really? Like that's like the depth of your intelligence or as far as you're willing to look because it's quite short-sighted. It's kind of like saying that, you know, when I've heard the same thing before, it was like when COVID happened and people were getting sick, people got really mad at me that I got COVID. They were like, you shouldn't have gotten it. You're the person who's telling us to be resilient. And I'm like, I never said that it wasn't a gnarly virus. Like I never said that you could avoid catching it. I just was telling you how to be resilient. So when it came, you were prepared. And then I hear people tell people on the internet, like cancer is all lifestyle and Alzheimer's is all lifestyle. And yes, there's some truth to the idea that lifestyle triggered the pathway that led you down that. But what a short-sighted thing to say. Like, would you blame your mother's Alzheimer's 100% on her past life behavior. I mean, to a large degree, it played a huge role, but also there's definitely genetic propensity there and there's toxicity issues and there's a lot of other variables. Nothing is clean or linear. I know the internet really wants things to be very clear, very black or white. That's just not how it works. There's multifactorial physiology happening here. It's the same thing with cancer. The healthiest man I knew died of cancer, my best friend, my mentor. And I watched it happen. He was the fittest, healthiest man I knew. And it was fast. So like, we got to have some grace because there are a lot of factors going on. And I will say this, your mother's womb environment and your father's health, as he delivered that sperm to her egg, has a lot to do with your health outcomes. So we can blame everything we want on the individual and be like, it's your fault that this happened to you and you should just try harder, which is such a terrible way to be. And really understand the epigenetic changes start in utero. They start probably before that. I mean, there's some crazy data. Every year I learn more and more and I'm like, whoa, this is crazy. The way that my grandfather ate impacted me, the wars that he was in, the stress levels that my grandmother endured, All of those things impacted my metabolic health, my hormones, my brain, my levels of how much anxiety and depression and cortisol and all of those things. Those are all epigenetic changes that occurred through generations. So anyway, okay. You guys can go read the study. I'll link it. You can look at it. It's just like when I read it and I saw a bunch of people freaking out on Instagram about it. And I was like, duh. of course you regain the weight. I mean, especially if we're talking severe weight loss, especially with the newer medications, I would fully expect that the faster it takes it off of you, the faster it's probably going to come back on, especially if there's no lifestyle intervention, especially if there's no behavioral modification, especially if there's no significant changes in the overall metabolic health of the individual from lifestyle, not just relying on monotherapy of a peptide. Like, duh. So just keep that in mind. I know some people really want to, they love it. They love anything to hate on the GLP-1, but I still think they're brilliant medications if used appropriately. I just think that we're not entirely using them appropriately in the grand scheme of things. But you got to understand that most doctors don't have the first clue about how to address metabolic health and they themselves are metabolically compromised and they've normalized fatty liver and they themselves have fatty liver. I mean, the cohort of folks I went through naturopathic medical training with and seeing them today, like the vast majority of them are metabolically compromised. So very few of them actually took fitness and lifestyle to heart as part of their lifestyle. Fitness was not emphasized. It was just food, food, food. That's all we got pushed down our throats in school was like the nutrition piece, the food piece. And I know that, you know, that's a big piece of the internet too. I see that with a lot of influencers, including many of my friends, like that's their platform is all food. But food is irrelevant if fitness is not involved, especially when it comes to muscle building. But that said, when it comes to like, if you're trying to lose weight, is it calories in, calories out? That's part of it. But that's definitely not all of it. Is it all hormones? Nope, but that's part of it. Is it the signaling peptide hormones alone? Nope, but that's part of it. And so taking a GLP-1 alone is just looking at it in that silo. Caloric restriction to no end, even with or without a GLP-1 will still lead to the same amount of muscle loss as cranking a GLP-1, by the way. And it's short-sighted. That's the silo. It'll work for a minute, maybe. Going to the gym, constantly working out three to four times a day will only get you so far before you completely blow out your hormones. And once you blow out your hormones, wait till middle age, like all these girlies that were bikini competitors and like just completely obliterated their hormonal system trying to get as lean and cut and muscular as possible And I see these girls clinically and they are dealing with amenorrhea and all kinds of issues. Like good luck in menopause because you can only, I speak from experience, you can only trash your metabolism so many times before it comes back to haunt you. So what you're experiencing right now, ladies that are my age and gentlemen, is the result of many decades of you abusing your system. Or it might just be bad epigenetic luck. It might be that you took a round of antibiotics and your flora got off and you've been cranking lipopolysaccharides out of your gut for decades. It might be because you have a really, really, really stressful life and decades of chronic stress have tanked out your metabolic health. It might be because you are completely hormonally disrupted for whatever reason, could have been like my husband, poor guy, like decades, his whole life being surrounded by chemicals, diesel fuel, fuel, oils and farm life, all the pesticides and herbicides, all that junk. He has just been up in it until he met me and we started being much more careful about it for him. But toxic burden matters. Which one is it? It's all of them. It's all of them, you guys. It's all of them. It's not one lever. There's no one lever we're going to pull and expect a miracle. So that's what I got for you. I do have a solution. I talked last year to Sarah Kennedy, who is the CEO of CaloCurb. And she was on the podcast. And I will make sure to link that right at the top of the show notes so that you can listen to it. CaloCurb is pretty amazing. And I have delved further into it after I even did that podcast and there's clinical research and it's solid. So I'll let you guys listen to that whole episode because I'm not going to go into it too much here. But there's two points I want to bring home. One is we have data on liraglutide, which is one of the earlier generations GLP-1s. And when you take that for an extended period of time, the study looked at what happens to your endogenous GLP-1 production. What happens to your L cells? Your L cells are the cells in your gut that produce GLP-1. They stop producing when you take super physiologic doses of GLP-1s. This was another reason why I was very keen on trying to introduce this extremely low dosing strategy. Because you will shut down L-cell production, which means you will not make your own GLP-1. So that is part of the problem that's happening that they don't talk about in this paper, is that we are landing in a world where people are cranking GLP-1s and completely shutting down their L-cells. Well, your L cells make a couple other things that are pretty critical to your appetite control. One being CCK and one being PYY. Those control when you feel full, like, oh, it's time to stop eating now. I'm done. How long you feel full for. Protein can definitely help. So the carnivore community loves to say like, well, just crank the protein and then you'll make all that you need. Without realizing a lot of people's guts are trashed and their L cells are pretty trashed too. that was part of my original hypothesis with the microdosing strategy was that we might not actually be functionally able to make enough of any of these things out of our L cells because our L cells are trashed from years, decades of having trashed guts. I know my gut has been chronically inflamed from way too much stress and just stress will do it, man. Kieran said last night on the masterclass that bouts of heavy stress are like taking bouts of antibiotics on your gut microbiome. And I was like, ooh, that's rough. But think of CCK as like your meal ending hormone. That's why they say to eat protein first because you'll feel full versus if you start with carbohydrates, your signal to stop eating is not as good. And then PYY is, turns your appetite down after you eat. And those both are suppressed as well if the L cells get trashed or if they get shut down from GLP-1 use. So CaliCurb actually is a botanical extract, and it's a special kind of hops extract, and it actually stimulates the L-cells. And so on that podcast episode, we talked about taking it as an off-ramp strategy to the GLP-1. So instead of just cutting GLP-1s cold or titrating down and then struggling, I think CaliCurb is a really great idea for a lot of different things. And in fact, really what I tried to get at on the episode is that when we bring CaliCurb in, we might actually have a sufficient microdose, right? That might actually meet the need of many who are wanting to microdose a GLP-1. It doesn't require a prescription. It's an over-the-counter supplement. You can just get it and use it. And that's the beauty of it. And so we talked about that there. So go listen to that episode. But also this concept that we need to stimulate these L-cells after they have been suppressed for so long on these GLP-1s. So I think it's a really great off-ramping titration down strategy. I also could see use concurrently for those taking retitrutide. The big complaint is that it doesn't really offer much appetite suppression. That's because there's not much GLP-1 in it. It's mostly GIP and glucagon agonism. There's very little GLP-1. So people wanting all the other benefits of a GLP-1, you kind of got to take something that's going to stimulate GLP-1 or be a GLP-1 agonist. So Calacurps fits that bill. It stimulates your own L cells to come back online and they have clinical studies showing that it stimulates GLP-1 secretion, the CCK and the PYY. So it's kind of a beautiful product that way. Now, not everybody tolerates it great. And I got some feedback from some of you saying, you know what, my gut just didn't like it. other people like my husband does beautifully on it. I do okay on it. And it's still something I would consider cycling. But I think CaliCurb fits a couple different needs here that we are going after. I personally am a big fan of the microdosing. And I think some of you are interested in that as well. So I think CaliCurb may fit that bill. This is not prevention treatment or cure of anything. It's just my thoughts around how CaliCurb works. The second part being people who do want to titrate down or off of a GLP-1 or an increase in medication. And then the third being using it in conjunction with something that may be working great. Like the retitretide may be doing what it needs for that patient's metabolic health overall, but they're not getting the appetite suppression that they want. Or maybe they're not getting the suppression of the desire to drink. Because really I have found that it's just semaglutide that does that. Terzepatide doesn't do a great job with alcohol cessation. So the CaliCurve seems to do it for some. So I am not making any promises, but I just wanted to throw that out there. I will put the link, I have an affiliate link for CaliCurve I'll share with you guys. It gets you a nice discount and I will put in the show notes so you can listen to that next episode. I would highly suggest you click on it next and listen to it because it makes a lot of sense. And I think it would solve a lot of this problem, which is there is no off-ramp in allopathic medicine. There's just crank the GLP-1, good luck. Oh, your insurance ran out. So sorry. Can't afford it anymore. You're done. Or, oh, so sorry. We shut down your LCL production and now they may never come back online well again. And so now these folks are off the GLP-1. They've obliterated their muscle because they didn't do anything else to protect it. They didn't eat nutritionally dense. So now they're severely malnourished there. They went from metabolically compromised to very metabolically brittle. And I have warned about this. I am very concerned about what's coming for a lot of these people. Bone integrity. Because the GLP, we got to understand dose-dependent response. There's a curve like this with most medications. There's the area, it's like an upside, it's a bell curve. There's an area where like we're getting what we want. We're starting to see shifts and it's good. And this is the same for supplementation too. And then we get to the top where we're going to see, and that might be a different dose for each person. We're going to see the optimal results for that individual. We're kind of checking off all the boxes, if you will. And then we can go too far and we can backslide down the other side. And I think the higher doses of anything, you're going to find yourself on the other side of that bell curve. And I don't think that's a great place to be. So CaliCurb, I think is a really great option for people to try. The other message I get a lot of is, does it really work? I'm like, yes, it really does work. I wouldn't put this in front of you. but it doesn't work for everyone. So I cannot tell you unless you try it. That's what I got. So people messaging me always after I talk about it on Instagram or I send an email, I get a ton of messages from people like, does it really, really work? I don't know if it's going to work for you. But the only way to know is to try. It's a supplement. It's not going to hurt you. It actually is going to, we have the clinical data showing that it stimulates L cell production. So we get the GLP-1 production. We get the CCK. We get the PYY. We get appetite suppression. and they've got some really great clinical data coming out that I cannot share with you about muscle and fat loss. That's very exciting. And so we're going to wait for that and we'll have them back on. I'll have Sarah come back on and hopefully live in the studio and we'll talk about that study when it is published. But until then, we kind of have to keep our mouth shut. So that's what I got for you guys. I hope that's helpful. If you are in this boat where you've been on high levels of a GLP-1, what is my advice to you? Number one, figure out how to find somebody to work with you to titrate back down, going cold turkey is not great. Number two, consider an off-ramp strategy like CaliCurb to keep that appetite suppression at bay because your brain is definitely programmed differently. If you've been in an obese state, your brain just behaves differently than those of your lean counterparts. That's no shame. That's just physiology. And so giving yourself that leg up, whether it's through a microdose or a low dose of a GLP-1 medication or it's through something like CaliCurb, I think is a really good strategy. Again, this is not medical advice. This is just what I would do and what I'm doing with my patients or when people are asking about like the physiology of the matter, I think this is logical. And then number three, you have to go to the gym. You have to go to the gym. I think I should just start and end every episode with that. You have to go to the gym. You have to build muscle. That's non-negotiable. My biggest bummer message that I get from people is, and I get it all the time, is Dr. Tina, you changed my life. I was so scared about GLP-1s. I was diabetic. I was overweight. I was worried about not seeing my grandchildren be born. And I started at GLP-1. It was life-changing. I've lost 40, 50, 60, 80 pounds. And now I'm going to start strength training. And I'm like, oh God, what have I done? Like, why didn't they listen to the most important part, which is first, go to the gym. First, go to the gym. So in 2026, go by the gym membership and this year use it, please, because, and I don't care what you do in there. Just move, start with moving. Moving is great. Get some morning sunlight, make sure your circadian rhythm is set. And please, for the love of God, consider a logical approach to HRT if you are hitting perimenopause or menopause. There are far too many studies. I'm not saying you got to go on it. And I know that right now on the internet, everybody's jumping on that bandwagon to try to monetize middle-aged women. I am not one of them. I have been prescribing HRT for decades. I don't take any new patients from the public. So there's no version here where I'm making money off telling you this. There are just far too many studies out there showing the protective benefits of getting estrogen in your body before your body stops making it. Please go find somebody that is knowledgeable to work with and consider at the very least if progesterone would be helpful to you because I have never seen someone's labs come back with normal progesterone. And consider estrogen replacement therapy. The transdermal does not have the risks that the oral does. Do not accept oral as a prescription. Consider what the latest data is saying, not what the 20-year-old data is saying that a lot of doctors are just parroting. They just are scared. They don't want to do it. They don't want to manage it. They're not going to run your hormones. They're not going to give you hormones. They don't want to deal with it. It's a pain in the ass. It really is. I quit prescribing HRT for years and just did regenerative injection therapy only and had a doc in my office doing the HRT because dealing with women in middle age is a pain in the ass. And dealing with HRT is like trying to hit a moving target if the person isn't metabolically healthy. So if the patient's not doing the things that they're supposed to be doing, and they're still, you know, and I'm to blame too. I get it. I've been there. Like you're still drinking the wine at night. You're not getting your workouts in. you're not getting your circadian rhythm set, you're not eating enough protein, you're not whatever, your stress is too high, you're fighting with your spouse, whatever it is, that all impacts your hormone response. And so it's like hitting a moving target. It gets very challenging. I think the beauty really is that strength training, HRT, GLP-1 conversation. I think that triad is beautiful and that was my original message from the get-go. So I think they all have a place, but we have to use them strategically. and in the hands of people who know what they're doing. And then you as the patient have to do the work. That's on you. No one's going to hold your hand and walk you into the gym and make you work out. So that's on you. I'll leave it at that. I will put the links for the episodes I mentioned. I will put the CaliCurb affiliate link so you can save. And I wish you all well. And I hope that this is helpful. Do not let this study freak you out because it's a big game of no shit, Sherlock. And the next time somebody gives you any grief about it, be like, well, if you quit your blood pressure medication tomorrow, would your blood pressure skyrocket? Yes. So there we are. I'll see you guys in the next one. Thanks for listening to The Dr. Tina Show. This is a Wellness Loud production produced by Drake Peterson. Theme song is by John the Gilt. You can watch the full video version of this podcast inside the Spotify app or on YouTube. As always, you can email the podcast at podcast at drtina.com. that's D-R-T-Y-N-A and if you like this episode please rate, review and subscribe on your favorite podcast app you can also find all of my offerings on my website at drtina.com for more shows by my team go to wellnessloud.com see you next time and thanks for listening this podcast is for general informational purposes only it does not constitute the practices of medicine nursing or other professional healthcare services including the giving of medical advice I am a doctor but I am not your doctor No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is intended not to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. If you struggle with bloating, gas, constipation, digestive issues, yeast overgrowth, well, you may already know about Digest This. It's the podcast hosted by me, Bethany Cameron, also known as Little Sipper on Instagram. I dive into gut health, nutrition, the food industry, and drawing from my own experience. I break down what's good, what's bad, and what's the best for your gut, your skin, and so much more. I even offer gut-friendly recipes. New episodes every Monday and Wednesday produced by Wellness Loud.