Would I ever prescribe Ozempic?

Would I ever prescribe Ozempic?

Would I ever prescribe Ozempic?

Check out the video on Would I ever prescribe Ozempic?.
Hello everyone welcome to Tuesday night we are live on the DR Boss Channel and I am so happy to see so many of you there on the chat helping me launch off on a Tuesday and I will tell you it has not been the easiest fast for me and most of you know that I fast on Sundays through this show and I'm definitely ready to eat I'm.

Going to start out with some traditions we have a great show tonight that we're going to talk about some a deeper dive into a discussion we did a few weeks ago that I left uh just superficial but have had some time to look further into it uh and that is the use of ozempic and whether or not I would prescribe it in a patient today.

Um I think you'll be interested to hear the topic and how going into this a little bit more in depth on some of the do's and don'ts so um just making sure everybody can see me there hello everybody uh again really appreciate all of you joining in right.

At the start of this um I'm going to start with a couple of traditions and while I do one of my traditions I'm going to switch screens because I have an interesting uh thing to tell you about before I go into yours all right so I've been using um the keto Mojo dashboard to run my.

Support groups so that I can see how well the folks are that are supporting grouping with me are doing this is my dashboard and you can see that was my glucose a few minutes ago this was my ketones a few minutes ago this was my DR Boss ratio a few minutes ago and I'm going to scroll down to the Chart down here while I do my.

Um well I do my uh numbers just to give you an idea of how this looks on um on the on the keto Mojo dashboard and encourage you that if you have a support group this app is something that you should have all of your folks dialing in and checking their numbers um together I'm going to show you how how this works it's pretty slick I am.

Checking my ketones right here in front of you I just pricked my finger uh and as you can see by the last glucose I'm definitely hungry but I'll hold this up to the front um to this area as I show you my glucose about the same it was a few minutes ago ketones about the same as they were a few minutes ago and as I it's beeping at.

Me as I synchronize that with my um my app here I'm just going to show you how quickly that updates uh because I I really love this tool and if you are in a support group uh there is no reason you should not be uh synchronizing your data with everybody in your group and it is one of the features that we helped keto Mojo say.

You want to have effective support groups use data use data and that dashboard really is a great way to follow the numbers get a hold of um what motivates you I'll tell you since I've been um you know doing my part to synchronize with several dashboards I'm doing even better even with the 21 Day master class.

All tucked away and not currently active meaning we do that class twice a year I'm really good during the class uh but I have lots of you watching me during the class so as you might expect when the class is over um I can I can let let loose a little and my numbers aren't quite as good so now take a look at this so I have just.

Finished up uh checking my numbers and synchronizing it and then if you do that little swirly thing now the glucose is uh 54 it was 55 ketones 2.8 they were three but the doctor falls ratio is about the same again that's the math but more importantly as I go down here what I uh want to show you and this is going to play into our talk later on tonight.

Is that I don't um I don't need to take ketones in bubble water tonight I am going to do that as a way to show you that yes when you take supplements they should change the numbers and these are the numbers I'm talking about not just that your pitone strip is a little bit more pink but you should definitely be seeing the.

Numbers Rise um I'm I'm super excited to say that I could be drinking uh the raspberry lemonade as of today but um because it just got back into the warehouse we have been out for like I don't know four weeks which is why I'm only drinking but pucker up because I didn't have any raspberry lemonade for.

Me either um but if you look uh you know there there's uh tonight right after the show started 604 but a half an hour before the show started there was my glucose my ketones and then um if you go back over earlier this morning I woke up this morning with a glucose of around 70 ketones of 2.5 that's a little better.

Marker of well actually that was when I woke up in the middle of the night and I usually would not check it in the middle of the night but I had I had pretty good energy and I was like wow I bet you my ketones are high so 2.5 in the middle of the night is not what I like to see uh we're gonna just pull up a few more of those readings so you can see them yeah.

So there's this other little drop down here I'm going to add 50 of them because I want to show you a little bit of a trend and again this gives you some insight as to what we're going to circle back to a little later on so there's what it really was when I got up this morning which is glucose is 65 ketones at 1.4 as you might guess my sleep score.

Wasn't great because of um because of that wake up in the middle of the night uh 4 30 again is pretty early I don't know why that's I don't know why I was up at 4 30 in the morning there's one that's not so good 6 p.m at night um again glucose of 80 ketones a 0.5 that was on.

Monday night after I'd been fasting 24 hours so you can see that my Trends um are better than they are when I have uh when I am but what I when I start out at my um so this was Monday morning if you go back to Thursday though you know that ketones 0.2 and the glucose was 93 and that was after I ate so again I'm just.

Trying to show you some real data from me and know that I do that because it keeps me accountable but it also gives us it gives me a chance to say there are some pretty awesome tools that we have out there to to connect and I don't mean just um you know connecting on a uh virtual level but uh that is like through Zoom.

But really saying watch and share those numbers with your support group um you know call into Mojo let them know we sent you if you're looking to say how do I use that how do I do that and then if you're buying strips we do have um uh if you put in Dr Boz as a promo code you get a little discount we are happy to are just so thankful for using.

Their um platform to connect our support groups and really say yeah accountability through data is pretty important I'm going to do two announcements at the beginning and then I'm gonna get to the lesson and do the other announcement at the end so stick around for that.

Um let's go to this here ketocon is coming up I am working on my um on my speech for that and I am talking to you about cholesterol so trying not to overwhelm the audience but also not lose the audience um I am looking to be there on August 21st and I'm really excuse me August April 21st and I think for three weeks.

Now poor uh poor Robin the lady who runs this and I have been trying to connect ephra live we think it's not going to happen this week I leave town tomorrow and um we'll have to try again next week but uh I really do look forward to meeting several of you there I don't have a booth this year but I will be present.

And answering questions and just participating in what I think is a really good community building and that's ketocon so see you in Austin for those of you coming uh um We're Gonna Save the other announcement for the end um but if you want a sneak peek you go to this page and scroll all the way down.

I'm super excited to share that with uh with with those of you that did that uh all right let's get to our lesson tonight because I I do want to cover um that this uh this topic really sparked interest we had lots of folks writing in asking questions and um as I looked at the um the improvements of uh how much I.

Learned by trying to find all the answers to your questions I thought okay I shouldn't try to do this with just the questions in the comments I should try to just repeat what I was learning about and didn't take a lot of time to um to get when I when I got deep into the the bowels of learning this uh or being able to explain it in a better way.

Um I do think that there is a higher message that I want to to to have um to have an answer to and that is ozempic has quite the craze across our country across uh the folks who are trying to lose weight that I've had several of my friends say will you write me that.

Prescription and I'm like um well you don't have diabetes first of all and they don't need to lose much weight um but let's go through why they're asking for it what the drug does and then what some of my thoughts are and why those numbers at the beginning of this show are really important for you.

To say what am I trying to get at what what's the point of um of having a um a weight loss in in the way that this drug helps our weight loss please put your questions into the chat we are there's already a couple of them that are really good relative to uh ozempic some of them that I saw you asked last.

Time and I have not answered uh hopefully some of that will be answered here in this slide deck but we'll get closer to um to seeing if I do that as we go forward all right so let's go through um just the basics of what does this do this is a drug that's been around actually a while it comes from the Venom.

Of a lizard and we've used it for type um type 2 diabetics in trying to improve their blood sugars and indeed it does improve their blood sugars but when you look closer at how the drug Works you're going to see why everybody's so excited about it so let me go over here and um.

All right all right so this um this is our this is our um glp-1 glp-1 is the name of the group of these types so they're actually more than more than ozempic there's a couple competitors on the market maybe that.

Will bring the price down for some of the folks um but the glp-1 inhibitor or excuse me glp1 Agonist so um acts like the the glp-1 is what this chemical is doing to our systems it La it acts like the uh in uh endocrine system that is in our system and I'm going to go through one organ at.

A time what this is doing to those folks that are taking it so um it is very much associated with weight loss and you're going to see a little bit on why the weight loss happens as I go through this you're also going to know why they have marketed this.

Um in a way that um that not only it helps diabetics but now is on the market for weight loss even if you're not diabetic you're also going to be able to see why the side effects happen so let's go through that so let's start with the brain.

Um okay we'll start with all of them uh let's uh we'll just focus here on um the neural protection uh when you look at what uh is happening deep inside the brain there seems to be something about the fat concentration in the in the brain that appears to have increased density of the of the um uh the the insulation around the neuron so it.

Has some neural protection but the most powerful thing it does inside the brain is it decreases your appetite this is beyond some of the other um mechanisms it's using like uh it delays I mean it decreases the gastric emptying that decrease of gastric emptying is a physical symptom but it is connected to.

That decreased appetite in uh in the brain so between the two of these this is some of the biggest mechanisms for why they are not are why they're not so hungry why they're actually eating less when they take this this next organ over here is your pancreas this is where most of the impact for the the glp-1 is making a.

Difference and that is inside the pancreas it will it does increase the insulin secretion we're going to come back to that in a bit it decreases the glucagon secretion so glucagon comes out of the pancreas and says hey liver we need some sugar so it decreases that um it increases the insulin biosynthesis.

Meaning it increases the production of insulin it does that by proliferating or advancing the cells that make insulin called beta cells it also does that by slowing down or halting the the natural death cycle for those cells that make insulin so beta cells proliferate or they make friends and they have.

Decreased apoptosis so decreased cell death of the cells that make insulin this affects all of your insulin sensitivity again insulin resistant is what most of the folks that watch this channel have they've had too many days of stimulating insulin too much insulin around kind of been brewing their cells in insulin for too long and that's.

Called that's caused them to be insulin resistant the insulin sensitivity happens when we reverse that it's what we were born with we were born insulin sensitive unless you were really heavy as a baby those 10 pound babies might have had some insulin resistance when they were born but for the most part you're born insulin sensitive and the.

Acquisition of chronically stimulating insulin makes you insulin resistant the use of ozempic and other glp-1 agonists increase the glucose uptake and storage inside your muscle so when it stops producing um or the the glucose over here that glycogen um that glucagon uh glucagon actually.

Goes over to the liver and says hey can you give me some of that stored sugar uh it cannot as that stored sugar comes out of the liver the blood sugar Rises this drug decreases that process and at the same time it increases how blood sugars are being stored inside your muscle cells which is normal I I do want you to notice that it does not.

Um it does not cause um the uh the production of or the does not have much activity inside the fat cells so there are a couple other cousins to this drug that are very active inside your fat cells but this is not.

Um all right so continuing around our little circle you've got a decreased glucose production over here in the liver that has a lot to do with that glycogen over in the other areas and then the last two they it has found to be cardio protective and maybe increasing the cardiac function all right so that's a.

Lot of the science behind what's going on inside your um inside the um the the chemistry of your body what I like to point out are the side effects for this start with nausea the nausea has a lot to do with that decreased gastric emptying there is some increased.

Diarrhea and constipation which also has a bit to do with the decreased gastric emptying for the constipation side of things those that got um the diarrhea they think it was a change in some of that um exocrine endocrine processes that ozempic manipulates other things like it does have some.

Slight increase in the liver enzymes and your amylase so amylase comes amylase and lipase come out of your pancreas and those tend to rise a little bit in the folks that are using it because there's a lot of activity that this drug does within the pancreas so the real question here is would I prescribe.

Um a a would I prescribe this to a patient and one of the key things that I um I want to go back to this hold on one of the key things I like to point out is that um ozempic does cause weight loss but in the the history of losing weight not all weight loss is the same not even in an.

Obese patient not all weight loss is the same that when we are looking at body composition for weight loss it has been very easy uh over the last especially the last decade using a dexa scan to see what part of the body was losing weight was that a fat loss or was that a um what is that a muscle muscle mass loss I have notes written over on this paper.

That I want to get to um um that when I look at the the key things for when I'm asking patients to check on their health look at how well their health is doing I uh I look at the amount of testimonials out there for um people that have said I've taken this ozempic I really have lost weight.

And then they're using a metric that I think is inferior especially if somebody's been struggling with weight weight gain on and off or obesity for some time and the one metric they're using is simply the scale that if the scale goes down then this must be good and unfortunately um if you've been around my channel a.

While losing weight has some some to do with um what the scale says but it has a lot to do with the psychology of why you gained weight and even setting the psychology aside if they're losing weight and it's the muscle mass that they're losing in excess from what would be predicted for a normal weight loss.

When anybody loses weight you're going to lose some muscle you're going to see some of that muscle mass change but it should be a a predominance of fat Mass loss during a healthy weight loss as opposed to muscle mass loss for starters the people who are losing weight in my practice they're not coming to me at 20 years old or 25.

Years old saying hey I need to lose 10 pounds they're 50 60 70 80 years old saying hey I need to lose this fat they are not asking me to lose muscle nobody that wants me to lose muscle I see a couple of you put out there yes the ozempic face is part of what changes here and I'm about to show you why why it changes and then what I.

Um we'll Circle back to answering that question here in just a second so let's go um over to here all right so this table is looking at the endpoints for um what uh the dexa subpopulation was in the treatment for uh this ozympic or uh some gluta uh glutide some glutath I always want to put another syllable in.

There they were doing the once a week injections and when they looked at not everybody got a dexa scan this is the sub population in that study that did get dexa scans again only 55 uh uh we're on or excuse me that's 95 we're on the the drug we had another 45 that were not on the drug so about 140 people had the dexa scan within this.

Study as you look at what they found the kilograms of total fat lost were about eight the kilograms of visceral fat again the most important fat to lose was less than one kilogram and the total lean body mass kilograms lost was five so when you look at this at percentages I wrote this down earlier I'm going to get my notes out so I don't do it wrong.

This is about 40 percent of their weight loss was in body lean body mass was lost about 60 percent was lost in fat Mass when you look at a healthy weight loss we like this number to be less than 25 meaning we know that if they there is a propensity for people to use the resources in their muscle cells as they lose weight it causes.

Um the sarcopenia or The Chronic muscle loss in um in a body that is very difficult to restore so when I look at um some of the some of the dangers that I think not only patients have when they're losing weight on ozempic um but more importantly what happens.

Afterwards so patients come in and they are desperate they have had weight loss or they've had obesity problems forever that overweight uh syndrome being overweight increases their risks of heart disease decreases their Mobility decreases their quality of life their Mental Health set aside the cardiac issues and the the.

You know their longevity what is their health as they age when when they reach for something that suppresses appetite yes we get a weight loss but unfortunately they are sacrificing a a grand amount of one of the most coveted resources that predict quality of life as they age that when I first introduced this what.

Was all over the news that week where it was something had happened on one of the doctor blogs where ozempic face was something several Physicians were talking about saying I can recognize when they walk in that they're not losing weight in a way that is normal and it's a it's a great um experiment if you would that the.

Human brain will recognize a pattern as a physician you'll watch as a pattern over time you'll see something and you'll say that doesn't look right and as they're losing weight they have a specific look to their face where the muscle mass is decreasing in their face and then they'll go into the dermatologist to say can you plump me up.

Can you fix that and what I contend is the danger is you get the muscle mass to go away you get the weight to go away the muscle mass comes with it and what happens when they stop this drug is that they did not fix the underlying problem they increased the production of insulin over time now we have an even more insulin resistant problem.

Even though the number of cells the mass is less and the return of weight is it's massive it's it's it's a like a tidal wave coming back into their life so I had my team asked me well would you ever prescribe that and I did not reflexively say no.

Um I mean it's a difficult position to be in when you look at how many things are are held back away from a patient that's suffering from obesity and knowing that a a chemical I can manipulate their chemistry with this drug the injection is about a thousand dollars a month.

Um they have to do this once a week you slowly titrate up the medication over time and it really does slow down that emptying of the the stomach the volume of food that they eat is much less the suppression uh the joy they're getting from food is much less but um but other things are getting better they're you know there's there is that cardio.

Protective area there is a little bit of neural protectiveness we know that it's not just the gastric emptying because we've had lots of drugs that have done that before but none that have been this popular in the marketplace for people who just need to lose 10 or 15 pounds and what I what I fear is not being communicated is that when when this is.

Being delivered in somebody who is um who is not uh who who's losing the last 10 pounds trying to get those last few pounds off that I I don't think they would ever sign up for I want to lose just as much muscle as I'm going to lose fat in those last 10 pounds it is almost always the.

Autophagy the recycling of proteins that have been hanging out in the in the you know in the spider webs of the body you know the place that nobody likes to look and nobody likes to pay attention to but it's been there a while and to get the body to reabsorb that why you need to ignite autophagy and the number one thing of sparking somebody's autophagy.

Is you must lower the insulin when you lower the insulin let me show you a couple things that happen um maybe there we go when you lower the insulin you can measure this okay so this is what is bringing me back to my uh my numbers here so a lowered insulin shows that the glucose will go.

Down and ketones will go up so as you look at um you know Ketone ketones are 2.8 and a glucose of 54. and then the ketones of three glucose of 55. those are examples where autophagy is happening uh when we look at a glucose of 70 ketones are 2.5 that was while I was.

Supposed to be sleeping and had I uh it's been a while since I had that high of a ketone in my sleep so I did wake up but had I slept through that my body would have been recycling protein while I slept and it would not be using the protein that is in my muscle that muscle mass as you lose it when you age becomes incredibly difficult to.

Restore and when you sacrifice the resource found in the muscle mass of of a young person it may be 40 years old saying I just need those last 10 pounds off and it did not remove the spiderweb fat you know that little niche of fat you know around their waistline that probably went on first has been.

There the longest and it will require a chemistry shift in order to take those resources recycle them back into the body and use them in a way that is healthy um and again when when you look at the the mechanism of action that is found in ozempic it is that it increa it goes into that pancreas and it stimulates a.

Lot it takes the beta cells that produce insulin and it makes them live a little longer it uh stops them from breaking down and it actually helps them replicate so you make more cells that make insulin which can be helpful if you if you needed that but almost every one of the patients that needs to lose weight needs to be lowering their.

Insulin which is how you spark autophagy as a weight loss as opposed to the um the the muscle mass that's being lost when people use ozympic so the question before I go to your questions I'm going to put put it out on the line that I will tell you that as a younger physician I probably would have written.

This drug uh you know it is so tempting when you're in that in that moment to help a patient lose weight and had I not seen the success that I've seen where patients really do become free of me they do not need to come see me in the clinic they're healthy they get to go away.

That freedom uh yeah it does take some education I think it takes a persistent group where you aren't just meeting to say how's the weather you're actually sharing numbers and thanks to keto Mojo and all the work that they've done to help me help you create a support group that really connects through the numbers uh the use of that dashboard for you.

It's free that's not they don't charge you for that I don't charge you with that I'm saying go create a support group and keto Mojo will show you how to have a dashboard that you can share the numbers with one another and um you know I don't prick my finger and check this for you just because it's fun.

I do this because it really changes my accountability well I want to snitch and have food that I shouldn't have or maybe eat a little uh too much in a setting I know that it's going to change my numbers if I'm the only one looking at it well it's kind of like you know the Charlie Brown saying that doing a good job around here is kind of.

Like peeing your pants and dark slacks you get a warm feeling but nobody really notices so yeah I might feel a little embarrassed but that I didn't do a good job but nobody noticed if I'm not sharing it and it's when I'm in community with other people because I need accountability too I get tempted too and that process of sharing those.

Numbers and being uh in a place where your your Chemistry isn't going to wake up tomorrow and be better it takes time uh to notch that metabolism in the right direction and when you get stalled well heck ask one of the people who's been in our 21 day course they know how to break a stall they know what it takes to.

Stimulate a metabolism and if if you need a refresher course come on by we are going to keep doing that class twice a year it made such a huge difference in fact tune in next week where I I talk about what what did I learn what are some of the things I learned in that class I'm going to take a minute here to.

Return to one of the announcements and then I will go over to your questions I see several of you typing in some of the good questions and I yeah I I've had these questions so good job let me go over here and show um hold tight hold tight uh oh here we go yeah that's what I want.

All right so Dr baz if you scroll all the way to the bottom I just want to say thank you thank you thank you for the people who have sent in video uh reviews uh these were super brave people that said I'm gonna record myself and upload the video to share that now I couldn't get the sound to play so I'm not going to torture you or me by pushing play on.

This but I highly recommend that you go listen to the folks that have left the reviews um I mean it means so much more when you hear what happened in their lives a couple other things that I am really thankful to say and that is we have been out of our raspberry lemonade we it is.

Back uh it is fully stocked praise God it took a lot longer than we thought but it is back in demand and again uh when you leave us a review we really do appreciate that um whether here or on Amazon I can't tell you how much that matters when people want to hear about a product they do not want to hear from me they want to.

Hear from people who've put their money out there and tried it and it just means a lot to to of those of you that have taken the time to do that all right let's get over to your questions I'm going to give a little bit of a heads up warning that I have a beautiful 16 year old who is about to start his high jump again tonight so he I will take.

Questions for about 15 minutes and then I'm going to duck out a little bit early so we're going to start from the question from Herbert he says how does one revert ozempic face not necessarily caused by ozempic but by too fast of weight weight loss do I need to spark autophagy well Herbert I did see your question right before I started my live.

And thought Oh that's the perfect beginning question so I I hope that you uh got the answer to that a little bit by saying when people's muscle is gone rebuilding the muscle is it's very difficult if you've ever watched somebody lose weight from um from their.

Um you know severe life illness like chemotherapy or um I've had a you know as a couple patients with ALS that really had muscle wasting a couple people with Ms those muscles just wasted uh now in in several of the patients with the MS it was a reverting uh relapsing type of multiple sclerosis and when they were not.

Relapsed the muscle would try to repair but you could almost draw a line around the muscles that had lost part of their Mass to restore it you first must control your blood sugar so if there's one place to start it would be checking what is your average blood sugar what is your hemoglobin A1c if your doctor won't do that you can order that from us it's.

A home kit you got to prick your finger and send it in but by golly for 40 bucks you don't have to fight the the system maybe it's 45 or something but it really does uh give you a baseline I'd want you getting that blood sugar stable before you start doing the next couple of steps when people have had muscle wasting that persistent presence of ketones is very.

Important to do workout for the facial muscles I guess I'd tell you to smile but that's uh that's not very easy to do for the muscle mass that's in their body the one that predicts long longevity you do need to have a higher amount of protein when you're doing that you also need to you need to.

Stimulate the muscle which means you need to tear it and then repair it and tear it and repair it I know that sounds crude but that's how muscles are returned in mass is that they are able to proliferate by injury repair Cycles that's called working out when you're a little sore after jumping rope it means oh those muscles in your leg uh tore a.

Little bit and now they're now they're repairing and that's how you restore the muscle mass the higher protein on a ketogenic diet is when you are trying to do that now I warn people do not hop to the high protein part before you get the fat off so when people have lost the weight and they're trying to build the muscle mass.

That's that's really where the prevention of losing that that weight is also a place where the fat and protein are a different equation um I the one of the biggest mistakes that I see people make is they hop over into a high protein State before they've lost the fat mass and they're too insulin resistant to be able to continue.

The progression of weight loss so they stall doc I'm stalled on the ketogenic diet and when you look at it they're eating a lot of protein and the fat amount they're not in ketosis that I mean check your numbers if you're not in ketosis you're not on the ketogenic diet if you're looking for that stability of muscle breakdown and the propensity to.

Use those old decrepit proteins that are laying around that's what you use a an autophagy if you want the menu to be those old decrepit proteins that are being recycled why you you should not be in a state of you should not have uh that high higher fat Mass that's still um looking to be empty meaning it's not that you don't get autophagy as you lose.

Weight but staying in a persistent state of ketosis while you lose weight many people push the protein it just sounds healthier like oh I'm on a protein diet I'm on a high protein diet but if you're insulin resistant you're not going to have the weight loss when you have excess amounts of protein taken in before your insulin resistance is.

Reversed and I'm content it's it's a good half dozen to a dozen years of people really persisting in a state of ketosis to to get the weight off and then to stay in a state where their body has has repaired and now is building that muscle back um right so I might be the same Herbert wrote it.

Another good question right after that which is what's the correct ozempic get out protocol well that that's a good question too so again what ozempic is doing is it's stimulating that um production of insulin so when they stop it you're going to see blood sugars rise uh you'll see that that.

Um the release of blood sugar back into the system is no longer suppressed and if you want to stimulate somebody's hunger uh get that blood sugar fluctuating up and down so you'll see a craving for food happen again when they go off of it um you know I think the dangerous part of that is when I'm guiding somebody off.

Of a drug that has been pushing their insulin too high whether it's a type 2 diabetic that's coming off of insulin whether it's a type 1 diabetic who's trying to reduce the amount of insulin they need or somebody who's been on a glp-1 where they've been pushing the insulin production and they've had this massive suppression of appetite what we.

Now need to do is awaken those hormones that do shut off do shut off your hunger but we need to do it in a way that's sustainable and healthy and those hormones come from fat so we put them on a ketogenic diet we put them on a very high fat low carb moderate protein but it's pretty Hardy amounts of fat and I don't play with it at the beginning I do.

It just like I would do a type 2 diabetic coming onto the ketogenic diet which is step one of the keto Continuum is is the phase where we restore some of these fat based hormones and I see patients come in all the time and they have way over to oh I want to do intermittent fasting or I want to do time restricted eating and they do that.

Without this the the bed the the foundation of fat based hormones and they feel terrible they they crave they're hungry they would never be able to fast for two days and feel good at the end of two and a half days of fasting and I tell you that um Step One is you see that um that book right there keto Continuum that workbook.

That's what I would be getting because I start with the psychology if they don't have a good why about what you're trying to do what are you doing this for then oh good lord the Cravings win if they get so stinking hungry the Cravings uh just sweep through their life and they're not on my plan for more than you know more than three weeks calling.

Back saying Hey I want that drug again because I am so hungry and I'm like yeah we know that that's what happens so I start them on a high fat diet I get them in that phase until they get to keto Continuum number uh three which is they accidentally miss a meal their their satiety is restored where they're like I was so busy today I.

Just a meal and it's the best scene because it tells me oh we've got a bed of these hormones that I want to use I want to pull these levers and use these hormones in their body instead of injecting it in for a thousand dollars you know a month I want your body to produce them and if you treat it right it can.

Good questions Herbert let's go on to the next one um so you previously mentioned it's best to lose some weight and then Plateau what changes do you recommend to achieve in a plateau all right so this is a another great feed-in to what I think patients really focus on when I say plateau.

I am usually not talking about a number Plateau you know the plateau that um that that most patients talk about is a plateau of weight loss so I'm going to assume that that's what you mean what you'll notice is that during a plateau I'm gonna see if I can be really sneaky here during a plateau this this isn't what you're looking at.

They're they're not looking at the the metrics inside the body as as you progress along the keto Continuum you will be able to watch using your morning frosting glucose morning fasting ketones how well your metabolism is doing and although it may Plateau for a few days it doesn't take long for the patient to say oh.

Not much is going to happen here in my body if I don't if I have a blood sugar of 95 in the morning and a ketone of 0.2 that is a chemical Plateau what I you know I I actually am really glad this question came up because it isn't just that they Plateau um I mean the key that's happening.

During that Plateau is that their weight hasn't changed but if you're paying attention to a season of your life saying okay I I teach people in the keto Continuum here's step one and then you do well and now when you're ready we'll go to step two but if you stay out here you probably won't go backwards as far as weight loss or weight gain goes but.

You're not going to progress and lose more weight in order to continue to lose weight I need to progress your metabolism to the next level and then stay steady when they're at that next skill level the one that they're trying to learn to hold the weight loss I need them to to master the psychology the reason.

People gain weight on ozempic is they didn't address any of the issues that were causing them to gain weight which is they love food for board you know they eat food for boredom they eat food for Comfort I mean we all do that that's normal but they have learned that their brain really finds such joy in food that.

They haven't developed the other places that they should have been recruiting Joy from in their life and as a result um the the skill set is missing so um I'm trying to figure out how to say this word two questions I'm trying to figure out.

How to say this name for recess I don't know okay so I I'm sure if I wasn't overly staring at it I'd be able to say that so whoever you are when I look at what I would ask people to do when they before they push to the next level of the keto Continuum I would be looking around to say do you feel good in this in this season each time we.

Advance the skills of either you know decreasing the hours in an eating window moving it closer to Sunrise you know letting go of one of the Comforts of you know adding cream to their coffee all of the places which on the first you know chapter of Keto were totally fine they allowed you to lose weight they are they are part of the rules but as we advance.

You to a place that is a higher push of your metabolism I have them assess uh whether they're comfortable or not so when I look at what things I recommend it is it's really based on the psychology and when I talk about the plan plateau of people losing weight I'm talking about the scale if you're watching the metabolism on the back side.

I mean you're cheating I mean that's what I do I would cheat looking what's what are my numbers and when your metabolism levels out when you can't get your doctor boss ratio below 100 well you're not going to lose weight you're chemically um um you're chemically not able to reverse.

It uh without um reverse the fat loss um until you get the blood sugar to go down get the ketones to go up which means you lowered your insulin a little further I mean insulin resistance what's happening with these plateaus is your insulin is becoming more adapted to this mass of your body and.

Um I mean it takes time to do that but you'll know not that you don't need to push very hard if your blood sugar is still in the 80s and your ketones are still you know 0.8 you mean you're you're getting it into the hundreds of uh weight loss so timing and chemistry really need to match up for those.

Um for those weight loss uh to the plateau to be reversed oh look at all these good questions okay j y writes in and says does ozympic change the gut microbiome to improve sugar well so the key thing about gut bike microbiomes is uh when people when they change the way they eat period it changes the microbiome when you look at people who.

Do fasting not only does the microbiome change their ability to absorb resources the next time they eat becomes improved that when you look at some of the micronutrients or micro minerals that get recycled they happen when that advanced chemistry I mean ketosis is one of those Advanced chemistries.

Um is is being flexed and that is in part part of that microbiome milieu the different types of of bacteria yeast that are are in the gut and growing and they they have messages throughout our body that that are reflected where I think medicine has really failed is for us to say oh you should do this to.

Make your microbiome better I mean we've had people say let's do a stool transplant take somebody's healthy microbiome and put it in yours and then we have people saying oh you need high fiber and people say oh you need no fiber and then you have uh you know you look at the the reason there's a million different ways to tell people how to.

Manipulate their microbiome is because the human body will adjust to what you're eating so if I look at what ozempic really does to microbiome the volume of food goes down and your body does what it's going to do which is change the microbiome I hope that answered that question um all right Lisa writes in and says is.

There going to be a problem with fatty liver with this drug you know what's interesting is the liver um the liver is where um uh so let's let me just show you this slide again just to pull that back up.

Let's go back over here all right so when you look at what was happening inside that liver the glucose production went down part of it was that that the the the glucagon secretion over there in the pancreas was also less glucagon says release blood sugar release blood sugar where the blood sugar went is it it now gets tucked into.

A muscle cell so it's stored in the muscle cells um and you don't you don't have any you don't have more glucose production it is really emptying that as time goes on um I mean we'd like to think that it reverses the fatty liver fatty liver.

Does respond to weight loss I mean it is part of the resources being recycled um you know I think part of the key thing that I am you know keen on is that that fat Mass there was not very active yes it released fat they lost fat weight 60 of their weight loss was from fat but 40 was from this was from their muscle mass.

During that time their liver enzymes all looked good they actually got a little better so I don't think that it's causing a fatty liver I don't think it's I don't think it's the best way to reverse a fatty liver but yeah all right let's go back to here BB writes in I ended up with afib after.

72 hour fast I have not been I had not been taking electrolytes but I had been eating real Salt magnesium tabs as well as floats add lights during the fast so what I when I see that atrial fibs show up during a 72 hour fast I I really do think that it was too big of a stress for that patient at that season just.

Like when people end up in Asana and they have quite the reaction to the sauna um I say you don't start with four minutes quit pushing so hard so if you're if your first 72 hour fast was after one 36 hour fast and that's like saying yep I ran a mile and then I ran a marathon so what I would ask your body.

To do is that that heart needs to get in better shape when you flip into atrial fib it really is a sign that you put a lot of stress on the heart and that your heart was not ready for that I know your mind was and your soul was and maybe the mitochondria in your liver was but if your heart has had a few too many trips around the Sun at.

The same time where that blood pressure has been high or it's been pushing circulation through too many pounds too much body's mass then I would tell you the next time around yes the water stability is important those electrolytes would have needed to be important but I would tell you that that's not the best way to to push your.

Metabolism I would push you to Asana for four minutes I would decrease your eating window to you know maybe it's at six hours and you go to five hours or slide those six hours towards Sunrise instead of later at night 72 hour fast they're they're attacks on the body and when you're healthy that's great when you're not so healthy.

Um yeah so all right two more questions and I'm going to check my blood pressure or blood sugar and ketones again and then I am I get to get ready to get on a plane tomorrow I gotta go to a track meet and then I go to a plane tomorrow questions here okay so Linda writes in.

Ozempic face how long after starting the drug before the face changes months years you know it really depends on um how high the dose was and then how insulin resistant was the patient when they started again ozempic face uh happens because the muscle resources um were easy for the for the body to grab so when you have the the onset is.

Well how quickly did it grab the resources in your muscles and if they were pretty overweight they were on the drug for six weeks I probably didn't use much muscle mass it's that persistent time where you know six months in they've you know they took sixty percent of the fat mass and um 40 of the muscle mass uh when they.

When they saw what that weight loss was over those I mean the study that I was showing I think was 62 weeks so a little over a year and it was a pretty significant shift in the muscle loss um all right so Tiffany writes in and says should I drink exogenous ketones um while fasting if not why I drink.

Ketones from keto OS and my Ketone production was gone down has gone down every day since eating the same diet as before drinking them all right so the purpose of ketones I mean why do I do ketones on this show not because my ketones are three at the beginning I do ketones on the show to show you what should happen in a healthy in a where.

Did I put that what should happen in a um is that the ketones should go up during a time where you drink the ketones and you measure them before and after what what drinking ketones during a fast is better than drinking uh better than adding fat during a fast.

But what I like to tell patients is that during a fast you want you you want to try to be as clean as possible if you're if you're reaching for your first 48 hour fast and you're struggling at about 36 hours adding ketones I mean the ketones I like to add are the ones that have no sweeteners during a fast so that would.

Be ketones in a capsule or pucker up so pucker up is liquid ketones they are really sour there is no sweetener in there there is no salt in there there's nothing in there but liquid beta hydroxy butyric acid so it's like a really sour lemon juice that's why the name is pucker up now.

Um that isn't for everybody it's very potent it is expensive um but you can also do the same thing with putting ketones in a capsule so taking beta hydroxybutyric salts and putting them in a in a capsule that's something I would have patients do during a fast what I tell them not to do is uh is to have this sugar supplements.

Those sweeteners in somebody whose insulin resistant I just think if if you're gonna fail fail to food if you're if you're trying to acquire this habit having ketones is better than having MCT MCT increases your ketones but it stops you from recruiting the fat from your body which is what you're trying to do when you put.

Ketones in circulation well there are calories you're going to have a little better energy but it does not stop your body from recruiting the fat that your system is trying to say hey I'm trying to open up this new Floodgate Of resources and I can't do that um when you put in fat then you stop the fat loss and if you're you're doing.

Intermittent fasting to try and reverse that metabolic problem uh you really do need to give the body the stress and that means don't um don't have um don't have the food go in when you're trying to ask your body just to to.

Increase the stress all right so let's see what these did in the last hour again this is a live show ketones or glucose of 52 ketones are 4.1 yeah so wow that's pretty good numbers now if I would synchronize this to my keto Mojo I would definitely have you'd be able to see that on my Dr balls ratio but if somebody else would help me uh on.

Um doing that calculation and putting it in the comments I would love that so I'm going to go off and be a good mom watch my son fly into something called pole vault check me out on Instagram if you want to follow that I do record him much to histogrin there are some other really good questions here so we might save those actually for next week because.

They really should be answered and I just want for anybody watching this on replay we are going to put ketochemistry as our video at the end of this tonight YouTube loves it when you click on that we get points for being a good Channel by offering content that you we think you would like so I think it would really dovetail into what I was trying.

To teach tonight about ozempic when it comes to how do you how do you learn more about that ketochemistry again during the live show we do not have any commercials but we do put them on on the replay so try to tune in with us Tuesdays 6 p.m eastern time and I will
Would I ever prescribe Ozempic?
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