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1. Philip Gatcha, DC

Functional Health Institute of Atlanta

770-948-2525

fhiastaff@gmail.com

drgatchadc.com

Dr. Phil Gatcha  01:26

And when we did the lecture, you were kind enough to invite me to remember asking the crowd, who believes in like detoxing, and I'm sure it was conjured up in people's minds were like, the 60s and 70s and hippies doing weirder fasts and like, waving a dead chicken over their head and like, Okay, now I'm detoxing this crystal help clean me up? No, look, if you go to the bathroom, you're detoxing. And there are certain nutrients, and hormones and enzymes that are part of that process, and you have them, your body works efficiently. And if you don't, the body will struggle in some form or fashion. That's a great thing for people to reach out. That should be that should be a podcast we do on how the body gets rid of waste from the time it's in the cells to the time you hit the toilet and get rid of that junk. And how do you make sure it runs efficiently? That would be a beautiful one. Did I ask you something, the doctor that came to me and said, Hey, again, this whole thing started. This wonderful friend said I want to put my dad on this stuff. They say there's no contraindications. They say that there are no labs required. The doctor said, Hey, what labs would you run? Study the drug come back to me, what labs would you would you run? And here's the data. So, I want to give you what tests I would run and why. Okay, and it's going to kind of inform us on some of the some of the issues that can come up. So, the first thing I ran cheap tests, by the way, very inexpensive. I ran a CBC on this on this doctor's father, and I wanted to rule out anemia. Why? Because if you're taking an appetite suppressant, or something that slows down gut, right, you're not gonna absorb nutrients. If you have an anemia, and we're talking iron, we're talking B vitamins, we're talking folate, well, then you're going to stress the body. Next one CMP. This is a test that rolls out kidney or liver disease. These drugs should not be administered if your kidney function is under a 15. And for those who are initiated, that means you're in kidney failure, and no kidding, you got bigger problems. Next, we want to check insulin, why if the person is diabetic, if the person is pre-diabetic, we're gonna want to repeat these labs frequently throughout their use of semaglutides or post semaglutide. And make sure that, that we're that we're handling that blood sugar situation properly and the medications are being managed properly by the prescriber. Next, insulin, hemoglobin A1C, those are the ones I'd read for that. Next, I will check lipase and amylase. Why lipase and amylase we think gallbladder we think, can you process fats. And so, if we're dealing with issues with the gallbladder, and this helps break down fat, we want to be we want to be on the ball with that. Additional labs, we always want to look at the thyroid. People's metabolism can be messed up because the thyroid isn't working right. And we screen for thyroid dysfunction. There's multiple mechanisms, but we also then look, the thyroid gives us a lot of information on stress. Did you know when you're stressed that same hypothalamus that picks up feedback from the entire body? How much physical chemical or emotional stress Is this human being under that thalamus communicates with the pituitary gland, the pituitary gland and tells your thyroid to speed up or slow down. So many of the folks we see coming into the office they have slow thyroids. Therefore, they have the symptoms of low thyroid, they're cold hands, they're cold feet, their body temperatures off, their hair is brittle, their skin isn't being replaced and repaired properly, their nails are no good. They're sluggish of brain sluggish of body and they gain weight. And they're saying, hey, I want to go take a drug to manipulate my physiology. Well, your thyroid isn't working. Okay, good. Do I need an endocrinologist? Maybe? Or wait a second. There's some lab values that show this is actually a stress response, holy cow. You need to go upstream to the cause what's happening physically, chemically, and even mentally and emotionally. That's got your physiology twitter pated. Right. So, the hypothalamus, the pituitary, and the thyroid axis is thrown off, that gets missed that I would look at uric acid. I want to see if the person has metabolic dysfunction. I checked the vitamin D, vitamin B 12. I checked folate. I checked magnesium. Why? Because if there's nutritional deficiencies, it's going to aggravate, you're going to aggravate a deficiency with a suppressant. I'd look at cortisol. If cortisol levels are off, and this is an endocrinologist problem, not a not a synthetic GLP one problem, then I look at stool testing, you beautiful guy brought this up earlier. If you slow down motility through the gut, you're going to decrease what's called peristalsis. So how long does it take for things to move from hooter to tooter? Well, when that happens, you're going to aggravate a dysbiosis. So dysbiosis is imbalance between the friendly and opportunist, opportunistic critters in the gut. Well, if things are moving through nicely, the body's used to the weight garbage in garbage out, we're good. But if the garbage kind of hangs out for a while, well, then the bacteria doesn't like it. Next, I would look at yeast overgrowth in the gut. Why? If you have a yeast overgrowth in the gut, you're gonna get terrible cravings, especially when you when you use this med because the yeast wants to live, and it lives on sugar, you're taking something that stops you from being hungry. Well, that yeast is going to send near death signals to your brain as it dies, is trying to make you feel awful. So you give in and start consuming sugar. And then SIBO, small intestine bacterial overgrowth, you hear about those people? Yeah, what those people they've got between their large intestine and small intestine, they have an invasion, you have friendly critters in the gut, and you have a really rough band of biker prison yard outlaws, that live in your intestine, right. So, these are the critters that if you go to the bathroom, and the bacteria from the large intestine gets on your hands, and you touch somebody's food, you could kill them. Yet at the same time, in that same digestive tract, where those bad guys are just north of those bad guys, you have bacteria so friendly, when you have a healthy person, you could take bacteria do a fecal transplant from a healthy person to a sick person, and their health improves. So one type of bacteria, you can honor somebody's physiology, but there's another type of bacteria in your body, you could harm somebody's physiology. And with a small intestine bacterial overgrowth, the bad guys are trying to push their way into the domain of the good guys. And this will be noted when you have certain foods, especially fibers, and you take a probiotic, and you get terrible bloating, terrible lower belly pain, like below the belly button, and also pain in your right hip, where the ileocecal valve is where the where the bacteria are trying to work their way to try to do what's called translocate, from the large intestine and invade the small intestine. So these are issues that many people if they had them, they know if they if you suspect, you have them getting found out before you take a drug and the side effects aren't that bad, but it has baggage.

Dr. Barrett 08:45

But I think what you're saying is that, even though I mean all drugs have side effects, but if you're able to acknowledge what will be side effects are and maybe mitigate the development of the side effects by some of the things that you've been talking about. Maybe that makes their drug experience that much better. Now they could take this drug versus not take it and realize the gains from it.

Dr. Phil Gatcha 09:10

The body doesn't need help. It just needs no interference. And those tests that I just mentioned, this was the best I could come up with for that doctor and say, Hey, these are the things that could interfere with your dad having the best experience. And he checked out clear and we're at 40 pounds or 37 pounds as of this morning was the check in call. So pretty cool. So side effects: mild to moderate side effects occur in at 81 to 95% of people so holy cow, everybody. Everybody. The common ones nausea and vomiting. We talked about that earlier. Materials sitting in the digestive tract, specifically the stomach longer. Well, your body isn't like things sitting around. So Nausea is that sensation of your body saying this is sitting too long. It's putrifying it's rotting. Get it out of me. So the CEO says of nausea all the way to fully express nausea which is vomiting, next, diarrhea, constipation. So most people are going to get some mild to moderate. But again, most people don't really discontinue due to side effects. I mean, the discontinuation stats on this were anywhere from 4.9% to 12%. That's pretty doggone good. Next, well, there's some other rare, less common side effects. And those are going to be we think of as we go, like the severe side effects are seen, it's going to be the bowels shutting down. Nausea, that gets overwhelming. We'll talk about that nausea, vomiting, diarrhea and constipation that get very severe. So let's let's jump into those now. The majority of side effects which you should know, occur after you increase the dosage. Why? Well, if a little bit of this drug slows down movement through the body, through the gut, as you increase the dose movement slows down that much more. And so titrating the levels, that becomes tough. So you asked the question earlier about, Well, how long does the stuff less than the system, I don't know how good your liver clearance, how good your phase one, phase two detox, I think that's going to play a role. And so, why in titration meaning how much a person uses is so individualized, the doctors, you know, gradually, like you go to all the companies, you go to their website, and they'll give titration schedules, like half a milligram and millier to 1.5 to you know how they just gradually increase it. But in every increase, you've got to watch the side effects. And the side effects usually come at dose increase. So again, let's the nausea. Nausea is due to gastric emptying. So your body also with this, you can't hold the same volume of food, nor can you hold the same volume of water. And so most people who are taking this medication, need to make sure they're getting smaller meals more frequently, almost like somebody who's doing a gastric sleeve, or gastric bypass. But you've also got to get water more more frequently. The patient that I'm talking about his his child who's a doctor was like, hey, Dad's getting all these weird headaches. I said, Well, what's his urine look like? Well, he was getting dehydrated and he just wasn't thirsty. Because the same parts of the brain I believe the thalamus there's a thirst and hunger mechanisms are right next to each other. You shut off hunger, you're gonna shut off thirst. So, the vomiting if somebody's dealing with vomiting. Then there's some really good new herbal strategies like ginger tea, like a really concentrated ginger tea, go to Whole Foods and grab ginger tea. It's like double the dose, like two tea bags and six ounces of water, not like one tea bag and eight ounces or 10 ounces of water. And there's something called D glycerides licorice DGL that works really, really beautifully on people with gut issues.  DGL D glycerized licorice.  And we use it for folks with gut issues all the time. And it's, it's wonderful. I encourage people to look into it.

Dr. Barrett 13:10

Is it just an antiemetic? Is that the primary effect?

Dr. Phil Gatcha 13:16

diglycerides licorice is going to help with it's a mucosagen. So, it's going to increase the protective mucus barrier. So, your digestive tract is a barrier system. And DGL helps to heal repair it it's also a mucosagen so, if things are sitting longer and they're sitting on delicate, fragile digestive tissue, if we can put a healthy coating of wax so to speak on that delicate digestive tissue, you're going to have less irritation.

Dr. Barrett 13:54

Alright, so let me let me ask you because you brought up another point about the effect on the gastroparesis and what about patients who have a lot of dysautonomia? For example, you're ever your diabetic population. A great example is they're going to have some dysautonomia, and that's undoubtedly going to affect the normal peristalsis of the gut, and they already have gut issues. You have to be a little bit more careful with that when you put them on that struck because of that?

Dr. Phil Gatcha 14:30

So, if somebody is dealing with constipation if they're dealing with a vagus nerve breakdown, so the vagus nerve is what controls peristalsis dysautonomia falls into that category. So, it basically for the layperson, it's less movement, less neurological signals to move the train along from hooter to tooter as we keep joking about. When you decrease peristalsis it will become far worse with semaglutides. And so for that person artichoke ginger root, Aloe is a good one like aloe, we use something with patients called Cape Aloe. Cape Aloe is good for acute bouts of constipation. Not to be used on a regular basis. But, but it's really, really an important thing I would have like with this patient of mine, who was trying to help dad out, we had them looking at the Bristol stool chart, and like going through all the phases of something called the Bristol stool chart to get natural idea, like we talked to her dad, and yeah, how do you do when you go to the bathroom? Oh, it's normal, uncomfortable conversation. When we pulled up the chart and made him show us and what was normal to him was not okay, it was actually more constipated. So, we're able to kind of see, hey, we might have some side effects coming our way. What do we need to do to head those things off? So yeah, with anytime there's a, there's already tendency towards things not moving well through the gut, and you slow it down. You got to be careful, the most rare one is gonna be bowel obstruction, which may require surgery, that's gonna be a rare, rare instance. But that's kind of like the air. We're in that kind of air. Right now we're talking about kind of very severe consequences. With diarrhea. That's a big one. So everybody thinks about what about the person that doesn't have good movement? What about the person who has diarrhea person that moves too much? Well, we'll get people who take this in, they'll get something called osmotic diarrhea. And they'll get something called overflow diarrhea. So you got to be careful if you're constipated, you'll get these what are called dry pockets of fecal matter, in the body, sort of liquefies the other fecal matter to actually get around it. So that will be called overflow diarrhea, when and when something's blocking the road, so to speak. And so the short lives of the road get taken so material can flow around. Again, that's when you start seeing the risk of a bowel obstruction that's going to usually appear in somebody that's constipated. And then they take this drug, and now all of a sudden they get diarrhea. That's a big one. Watch out for that. I've had a history of constipation. I go once every three days, which isn't okay. And now all of a sudden I get diarrhea. Oh boy, oh boy, I'm thinking overflow diarrhea, I'm thinking make sure get him checked out just to make sure we don't have an obstruction forming. And then we talked about osmotic diarrhea. So that means when you slow down the amount of fluid moving through, the body says, This undigested or unneeded material, these toxins, these chemicals, these critters that are in the gut bacteria, and so on, the body says Well, I'm kind of used to the moving through at a normal pace, it's going way too slow. So, the body will irrigate, irrigate the bowels, flood water in there, to do what to wash it all away. And so, with osmotic diarrhea or with overflow diarrhea, you want to think electrolytes that have no sugar added, you want to think taking broth, you want to think coconut water, fiber, and then try to figure out what kind of diarrhea and normalize it there's a lot to get into there because we can get into the microbiome is something called dysbiosis. But kind of an important piece of the puzzle when we're looking at side effects. So, when we kind of as we go through this, some other rare vicious side effects hypoglycemia kind of rare hypoglycemia with people doing semaglutide Just because the mechanism is just very rare. The next most common rare side effect would be pancreatitis, and so for people with a history of pancreatic issues could be a problem here. People with gallbladder issues people the sluggish gallbladder, gallstones history of blockages, that's semaglutide are a 28% increase in gall stones. And for those people using cholegogues for those people that don't know that's that would be for the natural folks, that's the naturalist herbalist is to the botanical peoples term a cholagogue is something that helps to clear out purge the gallbladder Yeah, yeah, purge the gallbladder to get some to get some material released. So whether it's sludge or actual stones themselves, cholegogues are really effective. Then with the gallbladder also you want to look at remember from school, the four F's female, fertile, the pejorative fat, and 40. Yeah, 40 you want to think gallbladder, female? Yeah, more tendency towards it when they talk about fertile. I think what they really meant, meant here when it comes to semaglutide and gallbladder problems. With fertile we're thinking more hormonal issues. So, this is a woman who's perimenopausal. This is a woman who's on birth control. This is a woman who's taking estrogen for any reason. And it's also a dude, who's testosterone is aromatizing. And converting to estrogen, you got to watch out for these things. And then the last one, kind of one of the very uncommon, but vicious side effects would be acute kidney injury, really rare. But when you do semaglutide, the decreased thirst and the GI side effects like if you get diarrhea or vomiting, well, you're going to become dehydrated and gotta watch for kidney injury. Not very common, the most chronic, the most common people that happens to are the elderly in polypharmacy, those folks that are just on, you know, handfuls of meds, and you've got issues.

Dr. Barrett 21:03

Well, yeah, well, you mentioned something that I was just thinking about. And that's polypharmacy. So we're slowing down, we've got mobility, motility, however you want to term it, how does that affect the bioavailability at some of the other agents that patients may be taking, because they may be taking a drug, which is fine, and it's doing great, and all of a sudden, they start on the semaglutide. And now they're their whole, not only is the microbiome changed, but the whole absorption milieu is affected, as they may not have the bioavailability of the drug, like they had before. Any data out there that says man you should really watch it if they're out of this might have to up the dosage.

Dr. Phil Gatcha 21:49

Yeah, that's why you better be in contact with your prescriber. So, some people get all ticked off at their doctor, a fellow who I love a friend down the street for me. He's been a patient and he is doing the injectables and he's mad, he's kind of hacked off. My doctor makes me come in every week for the injection. You know, that could just give it to me, and I could take it home. Well, yeah, they could. They could, but they need to monitor you for rate of absorption or developing any problems. And again, blood is gonna be the best way. But there's gonna be symptomatic clues. So for instance, one of the things we'll talk about in a second, when you're taking these meds and you slow down digestion, therefore you slow down absorption, when they slow down digestion and absorption, then you're gonna be missing out on micronutrients, your vitamins, your minerals, you're gonna be missing out on nutrients that, fire up something in your body called the mitochondria. Well darn sure you're going to be slowing down absorption of any chemicals that are being onboarded. And so, and the drugs you're taking orally? Are they fabricated in such a way that your body can, that they'll just eventually work their way in? Maybe, or maybe there'll be sort of slowed down and held out of the body? We don't know. We also know that, that the liver when you slow down digestion, liver's, part of the gastrointestinal tract. So, anything that messes with digestion is going to mess with the liver, well, the liver was gonna be processing those drugs. And then clearly, if you mess with digestion, absorption, you just mentioned the microbiome, the little critters that live inside of you, you throw them off, like the microbiome affects brain chemistry, hormones are your detox, musculoskeletal function, inflammation in the bloodstream, your mood, your memory, blood sugar balance, energy production, I mean, the list is, it's insane. The thyroid hormones, I mean, it's, it's a long list. So again, the people that look at this, and they say, hey, the people that come to me if they're if they endanger this drug, the baggage is worth the juice is worth the squeeze the baggage is worth is worth the benefits. In the same time, I get people who are very naturally minded, who say to me, Okay, I'm gonna use it, I'm gonna use this medication for a time, but I want to plan for when I come off it, or I want to plan for if I plateau, or I want to try to avoid this altogether and see if I can get my body to function a bit better, and work on it for me. And that kind of leads us to the next slide. What improves right so we had the side effects, what improves long term weight loss? Well, let's, let's set it here. Some shocking facts about this is when people take this med, most regain weight 50% of what they lost in about two years. And the rest of the studies. Within five years, most people have regained about 80%. And here's the deal. It's not for lack of trying, Dr. B. This ain't for lack of trying. Yeah, agreed. Big shirts that came up with this. The average woman goes on approximately 130 diets in her lifetime. Well, 130. That's the average number cuz I was looking at what what makes this fail and that data came up. So, motivation, that's usually not the problem. So, why won't it stick? It won't stick because of physiology. The results don't stick because of physiology. So, let's look at this thing. It's called the gap effect, or the energy gap effect. So, your body metabolically adapts to things. You go out in the sun, you get a tan metabolic adaptation. I go workout with my meathead friends, and you get stronger, that's an adaptation, I'm harming my body, or I'm putting stress on my body to elicit an effect. Well, losing weight, it has an adaptation to it. And this thing called the energy gap is the biggest reason people struggle. So, when you lose weight, your appetite slows down. Or excuse me, your metabolism slows down, your appetite increases. So why you get signals to the brain, this thing we talked about called the hypothalamus. And the signals are that you're being deprived of energy. And so, when the brain says you're being deprived of energy, or that you're losing body fat, a hormone called ghrelin, all of a sudden pops up. So, ghrelin is your primary hunger hormone. When you're feeling, not yourself, the snickers commercial, and you're getting hangry, and you're just not as ghrelin, your ghrelin levels are high. Now, this is part of the cruel joke in the energy gap ghrelin goes up, so your body is telling you feed me, I'm dying, feed me. While that's happening, your basal metabolic rate, your metabolism slows down. So, you're getting increased call to bring more up, your body's ability to burn off slows down. That's a cruel joke. And so, you begin to have a loss of your normal metabolic rate. Now, it makes sense. Because you're losing body mass, you're losing cells that normally were expending energy, so there's less of you now. So that's the less energy demands. But this is further exacerbated by the brain by this energy gap is the brain saying, I want to keep Stephen Barrett alive. If there's a famine, I want to keep Phil alive if there's a famine, so let me make him hungry. If I've lost any weight at all, I'm gonna make feel hungry, I'm gonna make him feel kind of crappy, and must slow down his metabolism. So, here's the actual numbers, we alluded to this earlier, for every 2.2 pounds lost, your basal metabolism drops by about 30 calories a day. And your appetite. And your appetite increases by 100 calories a day. So that means you've got a 70 to 80 Calorie gap. So, over the years, well, 70 to 80 calories extra day that my body wants to get in not a big deal. But in 10 days, that's almost a pound fat. So multiply that over years, then you got that, that adipose tissue coming back. And again, adipose tissue is a reservoir, the body wants to keep it and it wants to reacquire it if it loses it. So here becomes the sweet spot. This is what we're really cool with the research, you've got to get past a year. If you can get the weight off and keep it off past a year, then the brain resets itself and says, Okay, I'm a new Phil, I'm a new Steve, and I'm okay with being a little lighter, and it stops the crazy make you crave more; slow down your metabolism.

Dr. Barrett 28:30

So are you telling me that these stats where it says it two years if they stop the drug 50% don't gain back 80% after five years. But that doesn't apply if you can keep them off for one year.

Dr. Phil Gatcha 30:31

Yes, if you can get past that one-year mark, and keep up keep the momentum up so to speak, then what I saw is that your likelihood of avoiding that 50% gain after two years and that 80% regain after five years, you're going to do pretty good. And more than that as the rebound, that's what we really want to watch out for. Because again, that stat to me was kind of impressive. So, for every 20 to 30 for every two pounds lost your body's demand for calories, your metabolism, what you burn drops about 20 to 30 calories a day. But your appetite increases about three times that maybe three to five times that. So, it's kind of a cruel joke, it's your body saying, I want that fat. Give me that protection, give me that storage, I need that. So, any drop, you're fighting a double battle number one, it was to get the weight off the number two, once you get the weight off, your body then has mechanisms to protect you to try to put it back on. And with that number to rebound meaning not only do you put the weight back on, but it's usually that weight, and then some. And it's frustrating. So, we want to get into what are the strategies.

Dr. Barrett 31:38

So, let me interrupt one more time. I think so important here. That's a really important thing that you just said. And I think that almost any practitioner that is going to prescribe this to their patients should educate the patient about regain, if you're gonna be serious about this, you got to take this for one year. And this is the reason why. All right, so I think that's a really important nugget that the audience is going to get out of this. But then we haven't talked about loss of muscle mass in this. And that is an important thing. Because you know, muscle equals longevity, we know that. So tell me about that a little bit as to well.

Dr. Phil Gatcha 32:20

Well, if we go back to this slide here, so if they gained 50% of the weight that they lost in two years, that is that maybe 50% of a weight, but that doesn't mean that they're getting that muscle mass back.  Anytime you're losing weight, your body is going to lose fat, but you're also going to lose muscle. And it makes sense. If you're eating less, then you're going to be getting less amino acids, right protein, amino acids, the building blocks, your body can't perform its daily cell functions without enough amino acids. And so the body then goes to get goes to reserves. So, for to keep you living, the body goes to fat for its reserves, but to build you to keep you running to repair organs while you're sleeping or throughout the day. The reserves for energy are fat, but what are the reserves for repairing your heart? What are the reserves for rebuilding your liver every day? What are the reserves for healing and working on keeping the kidney up to par? Amino acids will tell me what those reserves live. Not in fat, they live in muscle. So, we take these meds decrease movement of food through the body. So, decreasing decreased intake of food. What's that mean? Then, body begins to eat into reserves, both fat and muscle that's totally ignored. So, you'll see people who are like, gosh, I'm not making gains in the gym, and my arms and legs are getting smaller. That's cool. One thing I'm really worried about is your heart. Right? That's the big one. Because the most important muscle of all is the heart. So, you've got to make sure you're getting enough protein. So, you don't stress the heart and lose muscle mass, which is going to go it's there's no sense like, I'd rather be heavier and muscular. With less body fat than be skinny fat. I lost. I lost. You know my dad, God love him. He's an awesome, dude. And he's in his 80s. And he's dealing with a heart condition that he was born with. And they knew it would come to visit them. And so, part of managing his heart is they want to keep his weight down. Well, again, my dad's a big dude. And so, I've known him most of my life in the in the three hundreds. My dad did some stuff. It's pretty amazing. If you knew him it blows your mind. In any event, he's not bragging to me every day. I'm three 300 Now 280. Now I'm 270. Now I'm 260. Now I'm 250 Hey, Dad, that's not normal. That's not normal in three months, that's not normal in six months. And I look at him and I say wait a second, your belly. Your waist is roughly the same size a little smaller. But look at your chest, your big arms. Your humongous calves my dad had calves are like 24 inches around. That's it's It's shocking. He was enormous. And at 85 He still has really big muscles but he's losing muscle mass and the doctors for his heart are saying we're just happy losing weight takes pressure off the heart. And I'm looking at that same what you said which is loss of muscle means loss of longevity? I want this guy right for 120 years. That's a scary thing. It's hard--you ain't gonna get back.

Dr. Barrett 35:21

Yeah, that's my point, you know. So, again, that goes to the nugget about why if you're gonna take this thing, you better take it for a year, so that we don't get this weight gain, because the weight gain that you get after you stop is all fat, no muscle, but weight loss was fat and loss. So it's a conundrum.

Dr. Phil Gatcha 35:41

You are behind, you're behind. So, you've taken stress off the system, but not in a good way. It's not it's not as beneficial as it could have been. So, this becomes the key. Do we take for length of time duration of time, maybe. But what about the doctors Once a patient hits the weight goal, or once they hit a blood sugar goal, they're going to pull them off anyway. So, you better have a strategy. So, whether you stay on for a prescribed amount of time, maybe good idea, maybe not, or whether you stay on until you hit a certain goal. But I would say you need to have a commitment of a year. Heck, you know, from the time you start this, even past the time you stopped to make sure you've got something in place to manage your physiology to make sure that you can backup the way you've already lost with proven weight loss strategy. So, this is kind of a really cool, like, note it jot it down portion of the episode because we're gonna go into proven weight loss strategies, that that can make a huge difference. So, can we ask what improves long and long-term weight loss success, diet changes are necessary. So, when we look at diet change, if you follow any diet, you're going to have results most people don't follow any low carb diets, as you might think, have a slight, slight statistical advantage, high protein diets, while they make you feel fuller, they increase your overall energy expenditure. So they tend to work better. And we like them. Dr. Barrett and I do simply because we protect that muscle. So, exercise is important. Why because you burn calories, but also we want to keep your muscle mass on. So again, to to keep your body holding muscle mass, you got to use it or lose it. Well, if you're taking this medication, you're really going to be losing a lot, both fat but also the potential of muscle stimulating muscle, it's gonna be pretty doggone important to make sure that that we're not, you know, dropping too much. We go back to proven weight loss, I wanted to hit something. So, before you even do these changes, it will be wise to correct the contributors to obesity. And so, we talked earlier about what contributes to obesity, well, depression, get that under control. If you have an eating disorder, this is really not a good, good thing. You got to get that under control. What if it's a thyroid issue? We talked about what if you have that Cushing's disease or you have a drug side effect? You've got to get that figured out and under control before you do this, then the diet changes make sense? So, we talked about the low carb diet. I like keto keto is great. It's safe by the way that the research on it a ketogenic diet is safe for people who are diabetic and want to take semaglutide. The problem with keto is it's usually not sustainable. Some people you hear those success stories of people stay on it for for forever. Most people it's not, it's not sustainable. But again, for type two diabetics, with semaglutide. keto work best, probably for the general population, a healthy and balanced Mediterranean diet that omits grains, that'd be a really sharp diet. Matter of fact, put this stamp it in the notes if people want that I created one for my patients about a nine-page beautiful. It was created for us. It's got beautiful graphics, a really wonderful, healthy, balanced keto diet or Mediterranean diet. I'll be happy to share you can we can send it out to the folks it's beautiful. Again, protein want to make sure you're getting that do we go into? Do you have a recommendation for protein consumption for people? Do you go with you know, one gram, one gram per kilogram of lean body mass? Do you one gram of protein per pound of lean body mass? Do you have a formula that you like to follow for protein?

Dr. Barrett 39:22

Oh, myself? No, because I don't I mean, that's that, you know, that's the area where, you know, I would put it back to the functional medicine guys like you, but yeah, that generally speaking, what is it that in a in most of the stuff you've read, it's a gram per gram and a half for per kilogram per day?

Dr. Phil Gatcha 39:41

Yeah, yeah. So, a lot of people do you know, the meathead of the gym says, oh, it's two grams per pound of body weight. That's a bad idea. The research originally was in kilograms, not in not in pounds. So, if you were to convert your body weight to killed kilograms, it's 1.2 to 1.6 grams per kilogram. Simpler rule of thumb might be take your body weight in pounds. One, one formula I heard is body weight in pounds, then multiply that lean get your lean mass. And then one one gram per pound of lean mass. That's a pretty good formula. Yeah, so let me let me keep going here. Exercise, initiate exercise plan. So you want to burn calories. So, when you're burning calories, you're exercising, you're depleting your glycogen, right, so your stored sugar, and that's what then causes the mitochondria of your cells. In order to keep making energy, they have to go through fatty acid oxidation. So, we exercise we burn some calories, we're taking semaglutides, we're managing a really great diet. But this exercise says I gotta get fuel from somewhere. So, what does it do? It goes and gets fuel from body fat, which is super cool. But here comes another issue. I'm taking you for a walk. I've got to get my, my computer charger here. So, you're walking through the palatial estate. That's my humble house. But yeah, I gotta get my charger. So, computers dying. So, here's the inside scoop. So in any event, when we are doing semaglutides, and we slow down absorption of nutrition, what's one of the big concerns? Well, if you don't get your micronutrients we talked about before, remember those. So, your vitamins and minerals? Well, it's these micronutrients that keep that keep your mitochondria working in the mitochondria are what produces energy, and says in any event, we want to consider if you're exercising, and you're doing semaglutide, it's probably making sure you're on a really healthy vitamin mineral with our patients, we use something from our store called micronutrient caps.

Dr. Barrett  41:53

By the way congratulations on getting to your acceptance to you UGA.

Dr. Phil Gatcha 42:05

So, in any event, we make sure of patients that that decide to go on this are taking a chelated micronutrient blend. In our clinic. It's called micronutrient capsules chelating it's bound with an amino acids. So, all the nutrients in there can get into the bloodstream really quick, whether or not digestion is slowed or impaired in any way. So that as we need your mitochondria aren't working properly, your weight loss is going to happen but it's going to be slow. If you keep those suckers fired up, holy cow, you'll maximize what you're doing with this medication and that's, that's a that's a beneficial tool. Next, again, lifting weights, greater muscle volume right there increases metabolism. And again, it minimizes lean muscle mass loss, which is your point with semaglutide You're gonna lose common side effect losing muscle mass, but exercise wise, how much should you get? I keep getting shocked and awed. Every few months. The lead cardiologist with the Mayo Clinic, put out a research study, I think it was University of Missouri he did it with but new parameters for exercise. And I was shocked and saddened because I hate doing cardio. I don't like going for walks I definitely don't like jogging at the weight that God put me under I'm not made for lots of wind sprints. So, I would do my exercise as all weightlifting. My cardio was weightlifting, my muscle stimulation was weightlifting, we found out that the positive beneficial effects of weightlifting dies at about 60 minutes a week. Well, I was getting I was getting six to eight hours a week of weightlifting.

Dr. Barrett 44:19

And that's a really that's a hard concept for people who are in the biohacking world because that feeds a lot of endorphins to them. But it's a it's a feel-good thing but it's hard to get people to understand and you need a day or two recovery as much as you need the need exercise as well and that you know.

Dr. Phil Gatcha 44:40

They think they're getting recovery because today was chest day and tomorrow will be leg day and then I have back day, and then I have arm day then I have lateral oblique day that I have. Problem is your hypothalamus and your pituitary gland that are generating your hormone production and your growth hormone. They don't get a day off. Right that's what And from what I was really shocked to see the research that said that the benefits diminish after 60 minutes to the point that it's that it would be better had you not lifted at all? Well, you know, that was shocking. I'm still having a hard time wrapping my head around that. But maximum longevity benefits on weight training are put it right around 24%. Now, so again, if you're going to live to 100 years old, genetically, you'll get that full, you'll get that full 100 years if you if you get your weight training every week. If you don't do it properly, or do too much or don't do enough, then you lose 24 years, you might get to 76.  But It shocks me because you would think you would think that well better to overdo the underdo. Well, this is one of those situations where we're overdoing is terribly rough. Again, still having a hard time wrapping my head around that research. I don't like it, I don't want to believe it, but it's what it is. I'm actually, as soon as that research came out, it got into my as soon as I heard it, I immediately did a blood test saw that my thyroid was slowing down a little bit it, there's no problem with it, it just wasn't optimal. So, it's alright, we're gonna do a little experiment here. And I switched my weight training. And I have three more weeks, and I'll be at two months of doing a large amount of cardio, and no more than one hour of resistance training a week. And I'm gonna check my blood and see what the thyroid is doing, and see what the brain communicating with the thyroid is doing and see what my hormones look like. And I'm hoping to see the benefit. I'm feeling a lot better.

Dr. Barrett 46:44

Yeah. And that's a great study. I mean, even though it's an n of one, it's very valuable, because she helped me out why I did that progress on and monitor yourself from that standpoint.

Dr. Phil Gatcha 46:53

I wake up every morning, you know, you hit the ground. And sometimes like the old injuries, the knee, the hip, and the ankles that are sore, they feel like you're standing on glass, and you got to take like 30 steps to start to feel like a human being again, that's all gone now. So there's got to be something good happening here. Related inflammation, and again, chronic overtraining, you're going to be chronically inflamed. Let's see what it does to my endocrine system, and then I'll give you, I'll give you more feedback. When we talk about cardio, every 1000 or so everyone to 2000 Steps walk there's a 10% increase in longevity, you know, 12,000 is the max benefit they measured. But we're seeing research now, when I'm when I'm looking up data for patients on how much how much walking, they need to get a day, it's like 10,000 steps a day is the is the recommended. That's kind of aggressive, it's five miles, we need it. But again, our lifestyles don't allow it, I know I don't get that. And then so as much basically as much low intensity as possible, then we get into the realm of the moderate to high intensity. And so, for me, this comes in the form of getting on my recumbent exercise bike, and doing sprint intervals, 30 seconds of high intensity with a minute with 90 seconds of lower intensity. And I'll maintain when I do that, within five minutes of starting that exercise, I'll maintain 85% or higher of my max heart rate, which is really good. I do it for 20 minutes. So, on a good day, I'll do morning and evening. On a great day. I'll do morning, midday and evening again. So, I'm getting 40 on average minutes a day of of 85% of my max heart rate that's high, that's high intensity. Great for the brain, great for hormones, great for natural nitric oxide synthase in the bloodstream. But what I'm what I'm doing 20 to 40 on a great day, 60 minutes a day, the recommended on that when you're in the active weight loss chasing zone with semaglutide 150 to 250 minutes a week of that to achieve weight loss, okay. So, 150 with like really kind of cranking it really pushing yourself. I'm at 160 minutes for the week. So far, it's Friday, I've got a lot to go to get to that. And so, it ain't easy to actually do it and be and be honest and legit about it. Now get ready for this to maintain your weight loss. So, to achieve the weight loss you need 150 to 250 minutes of that moderate to high intensity. Once you get the weight loss, it ain't smooth sailing, you have to now increase from 150 to 250. You got to you got to migrate up to 200 up to 300 from two to 300 minutes a week now to maintain the weight loss. Oh, yeah. You better. Yeah, that's a big increase. Because you have to overcome the energy gap that we talked about. Big deal, man. Big Deal and that's a that's a gone it's almost depressing. Yeah, but it's the fact the next other factors, we look at ongoing interaction with health care groups. Why do you think Weight Watchers has worked for so long? It's the Alcoholics Anonymous meeting with people support. What is the outcome Alcoholics Anonymous for weight loss decreased screen time. Man, you know, when you're screen time, and you've I, I do I become a zombie and what happens? Well, I wake up in a pile of processed snacks that I should have never touched. Right? Right, so, so I know darn well, screen time messes me up, doing the frequent small meals throughout the day two to three hours, make sure you get breakfast, time restricted eating. Now, this doesn't mean intermittent fasting. I love intermittent fasting for 25 to 30% of my patients. But time restricted feeding means getting at least an eight hour right when you're sleeping, the 10 hour stop time, there was research done Nobel Prize research on fasting mimicking diets that showed if you're in that 10 to 12 hours of not shoveling something into your body, it gives you the gut, it gives the immune system it gives your body a rest. You signal autophagy body gets rid of weak dead dying mutated cancer cells. Start restricting feedings a good tool, then portion controlled meals meal substitutes, so you know, portion controlled. When you're on this Med, you're going to eat less. Just make sure that you're prioritizing things like protein. Also, we're finding with patients using those like fresh meal kits that you they come in the mail, they're already prepped, that's been a help frozen meals kind of stink. But there's people that come to me and that's literally the best they can do. So, okay, we got to do what we got to do. So. Yeah, so that's what we got there. We'll get natural alternatives in a second. So, let me let me go into a couple really cool additional support pieces. So, we hit the hit on this earlier. So, I'm gonna repeat one thing. So complete protein powder, why getting a protein shake, they're filling, their calorie controlled. They act as a meal supplement that supports holding on to lean muscle and it supports getting the fat off. Next one we talked about a little bit ago, micronutrient increase your micronutrients vitamins and minerals. Why? Because we want the mitochondria in the cells of your body to keep firing. So that we can keep the fat loss going preserve muscle mass. It's interesting that most people, I'm looking for a stat here, mitochondria, mitochondria. Again, the energy producers of the cells are compromised are proven in research to be compromised. And most most everybody with chronic obesity, the mitochondria complex. So, your oven, your engine, what burns fat doesn't work as well. So, number one is protein number two, get the nutrients, the vitamins and minerals that support the mitochondria. Now, number three is liver support. So fatty liver and obesity 80 to 90% of people who are obese are dealing with some form of fatty liver, what level of infiltration is going to be, you know, up to the individual. Next, hepatocytes, the cells of the liver that get rid of waste for you along with doing about 500 other jobs. Hepatocytes cannot perform phase one and phase two detox pathways adequately. So, for your body to take waste and send it to the toilet. You have two phases to go through. When you're dealing with somebody who's overweight, obese really the liver is already struggling, you've put them on this bed, Why might it might not work, why the liver is not keeping up. Also, fat soluble environment, toxins accumulate in this in adipose tissue. So, we talked earlier, you got some weight on you, there's probably gonna be some toxins in it. As you start getting rid of that fat those toxins now burden your bloodstream burden your lymphatic system. So, there's got to be something to get rid of it. And so now we can go into the botanicals that are shown to make a difference. So, using something called hibiscus, using lemon verbena, using green coffee, they've been demonstrated to increase your own endogenous natural production of GLP one, and they decrease ghrelin. So, what do we got? We got similar effect is not going to be as strong as the drugs that don't hear me now. Don't get as strong as the drug. But your own GLP one boy, I can't love a drug as much as I like what Phil's body makes, and you can't love a drug more than you like what Steve's bodies makes. And so we can increase our own production naturally endogenously and at the same time, decrease ghrelin. The thing that makes us crave and hunger, we're in good shape. So the lemon verbena and hibiscus coffee bean extract, do a heck of a job and who wants that? This is the person who can't do semaglutide This is the person who is stopping semaglutide Or it's the person right who's just look, I just want a natural approach. I want to see if I can do something. I like to think of it differently. So yeah, there's the person who doesn't want to ever get on it, that's fine. But we'll use this with doctors who send us patients. And we'll use this protocol. With the verbena, the hibiscus and the coffee bean. We'll use it for people on semaglutide. But they're having a plateau they can't break through. So people who want to skip it altogether, people who are plateaued, but then we go, people who are done with the semaglutide. And they they're trying to prevent the rebound the weight gain, or people who've succeeded will use this for people who've succeeded, and to help keep the weight off to get past that year. So, they can comfortably look back and say, Okay, I didn't put the weight back on. And there's what it does the verbena, lemon verbena stimulates metabolism, decreases fat production stimulates fat, use for energy, it's anti-inflammatory, stimulates blood flow, and hibiscus, gets the metabolism cranking stops your body or inhibits the body from absorbing fats. And carbs when you're eating kind of cool, stimulates the body to burn fat for energy, it slows down inflammation, fights inflammation, really neat effects with lowering blood pressure. Hold on, come on slide. Nice effects of lowering blood blood pressure. The research on this was systolic numbers after six or eight weeks came down 20 to 22 points. Pretty cool with dogbone, hibiscus. And then green coffee bean stimulates metabolism inhibits some absorption stabilizes blood sugar anti-inflammatory. And so, like in our clinic, we had a we had a product, we call it crave control. The companies that produce our nutrients for us. And it's been a pretty doggone neat thing to do. I'm just shocked when I take it. This combination of material, I'll take one at lunch one at dinner, I'm really craving things I'll take to a dinner. And it just shuts off those wild cravings provided I have eaten properly during the day. And so far, this experiment for me, I've done it for about six weeks, right now down about this is for me doing my exercise, and using this with a ketogenic diet, or at about 30 pounds lost. And so, you know, I got about 30 more until I'm lean and mean, but it's pretty good.

Dr. Barrett 57:19

But, Phil with these natural alternatives to semaglutide, you have to look at the side effect profile. You're not getting nauseous and having a lot of GI distress or distraught.  Correct? Not at all. Okay, so, so maybe, you know, maybe there's someone out there that says, you know, I would really like to look at this semaglutide, maybe I should just try one of these more natural alternatives first. No, they weren't. It's certainly going to be less expensive I would think. And yeah, yeah. Their insurance issues that say that that's not the case. But gentleman's taking initially natural supplementation. It's always has a lower profile of adverse events and has it's it's less expensive.

Dr. Phil Gatcha 58:11

The cost is wild. Yeah, we've seen actually saw a sign on the side of the road, looking for semaglutice, only $399 a month, like holy cow. That's a lot; that remember when we were kids, that was like a car cost that much. And now you get that to lose. It's late, right? And you got to stay on it for a long period of time. And you might lose 15 pounds. Holy cow. So yeah, there's got to be the baggage, we talked about side effects, but also, some of the baggage is of the cost.

Dr. Barrett 58:40

Can you can you provide me with that study the length of the reference that you had for the exercise benefit? I guess, I would love that.

https://articles.mercola.com/sites/articles/archive/2024/02/11/nailing-the-sweet-spots-for-exercise-volume.aspx