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Philip Gatcha, DC
Functional Health Institute of Atlanta
770-948-2525
fhiastaff@gmail.com
drgatchadc.com

Dr. Barrett 00:00

My guest today is Dr. Phil Gatcha. Dr. Gatcha is a chiropractor by training. He's been in practice for 24 years with his wife, Bridget. And he is really one of the true leaders as an adopter of functional medicine as a way to create custom tailored solutions to very complex physiological problems. And by addressing the cause, rather than just the symptoms. Today, we're going to chat about ozempic or  semaglutide. I know that you've had to have heard about this drug because it is the craze and the rage right now, for people to lose weight, we really go into a very deep discussion on not only the pharmacology of Ozempic or semaglutide, but also some general physiological concepts of nutrition that I think can find very interesting. So please enjoy my conversation with Dr. Phil. Gatcha. Introduction and his journey.

Dr. Phil Gatcha 02:30

It's an unusual path. My background originally started in working for a French and German pharmaceutical company. And it was in the development side of it. And through some injuries, sports related, I had a doctor kind of come to me and start talking to me about root cause of injuries, root cause of health problems, and that led me towards Chiropractic and a very specific kind. And so I kept my laboratory background, but then I really loved the physical side of like, Can I do something to improve somebody's health and through the nervous system was a great way you, you and I have worked in that area together. In any event, that concept that your body was designed to heal itself, the body was designed to be healthy, and it works. Sometimes when we give it the wrong input, and it's always trying to do the best it can with whatever we give it. Well, it just led to a career of 25 years now of looking at the human frame and saying, Okay, what's at the root cause of why this person's body isn't working from a physical perspective, from a musculoskeletal perspective from a biochemical perspective. And so, our practice has evolved into a pretty big functional medicine practice. And with that, this particular topic, I had a doctor who was a patient who said, hey, my dad is morbidly obese. And he's got multiple complications and the guy is in trouble. I want to go on ozempic. And he said, there are no blood tests required for it. And he said, but being your patient, as long as I have, he said, I want you to go and do your analysis and my dad, what do you think we need to look into? What ways can I make sure that we're putting him in the best position to succeed? And that led me down a path of okay, I got to become somewhat of a well not an expert, but have a formidable knowledge base on what semaglutide is. So, from that challenge from that doctor and a patient who I love, it became something that got really interesting and has gained quite a lot of attention.

Dr. Barrett 04:46

What do you think that's caused this groundswell of interest and talk about ozempic? It's almost like it's just had this meteoric rise. What do you say?

Dr. Phil Gatcha 05:04

We like easy stuff. Plus, it works. How it works? Are there side effects? Yeah, we're going to talk about that. are the side effects, the baggage that comes with this medication? Is it that big of a deal to most people--no. For a lot of folks, it's so beneficial, that it's worth it's worth having in your life. The problem becomes when the in the rare instance that the side effects are too aggressive, number one, number two, the problems become, what about when you get off of it. There's a big epidemic of problems that happen. The regain of weight, there's this thing called the gap effect that we're going to go into pretty heavily today. It's that it's this idea that for every 20 to 30 calories, or well, let me put it this way, for every 2.2 pounds, you lose, your body has to create a certain calorie deficit. Well, your brain looks at fat, and it says, wait a second, that fat is precious. That's my body's Fort Knox fat is my ability to survive against future. Future austerity, starvation. So, you take that fat away in this gap effect is your brain, it turns on a mechanism where it says, I not only want you to gain that weight, we lost back but I want more, this rebound effect. So, we had to put in place for people that we work with. For some people who don't want the drug. Is there a way to help them get benefits without it? For the people that hit a plateau? Either on the drug or not? Can we get them through a plateau naturally, and then last the person that the medication is no longer effective insurance doesn't approve it. Remember, it's a diabetes drug. So, these people who don't have diabetes anymore, or they hit their weight loss goals, insurance, their doctor say you don't need to be on this and the person still needs support. And we don't just want to let them freefall back into massive weight gain. We're going to talk about how, how quickly people gain weight back and in what timeframe? So, is this med awesome? Why do people want it? Because it works. Like it really works. But this idea keeping people on it long term? Yikes. It's got some, it's got some problems, got some baggage. Let me interrupt you. Because I think we've got a lot of things to cover on this today. But let's talk about physiologically. And I don't know this. And that's why I'm asking do you know that? You know, we talked about brown fat versus regular adipose and brown fats being you know, something that is it's kind of fresher? Because it it's just been a metabolic standpoint, the habits thanks to often really, I guess this is a way to put it. What does semaglutide or Ozempic do as far as brown fat versus just normal adipose tissue? I think the body is going to discriminate. I would think, I would think I mean, the body's going to access whatever fat stores it needs. But well, fundamentally, anytime you anytime you're removing, I mean, what does Ozempic do? It affects the stretch receptors in the gut was something called the glucagon like peptide number one receptor. So, when you and I eat, everybody knows that feeling of that huge meal, we've overstuffed yourself. And if you're here, you look great. So, I don't know if you've ever had that. But, but some of us, and that, that stretch reception feeling where you you've overeating. Well, that's driven by a hormone made by the gut, glucagon like peptide receptor number one. And what Ozempic does is it works on that receptor site. And it tells the brain, okay, we're full number one, number two, it works on the hypothalamus, and tells the brain hey--look we're satisfied. Let's not get into fat storing mode, and there's a little bit more to it. So, then what happens is the body still has its needs your muscles and your organs and your brain and your all your physiology has needs. But now you don't have this hunger. And we're gonna talk about why some people have more hunger, and what are the mechanisms that make people overeat or that make people hold weight? But you get this concept where the brain isn't wanting food, your body's telling you, I don't need food? Well, it's got to draw those those resources from somewhere. I would think the body would preferentially go to adipose first. Nowhere in the research because I thought about does it go to brown fat Brown fat, that's more of a protective. I think adipose regular adipose is where the issues are going to come. In most of the research when we talk about ozempic When we talk about semaglutide and losing body fat. A lot of the research we're going to talk about like you want to make sure you're detoxing. Well, why won't you losing fat fat as a storage place for toxins? So, we're going to hit on that and so that came up quite a bit. Well, that's gonna be adipose tissue, that's gonna be your normal body storage of fat subcutaneous, or, or the visceral fat. Brown fat didn't come into the, into the equation in any of the research I did so far. So I would think the body is smart enough to hold on to that precious resource. But I mean, I couldn't, I couldn't say one way or the other definitively, but I would think it goes after adipose. And then if you dip so far into adipose reserves, it'll probably hit brown fat after that. So, again, your doctor, if he has you on this, she has you're on this drug, they're probably going to pull you off long before you get to that point. And we'll talk about some of the parameters or when doc start pulling people off. And when it's time to be done with

Dr. Barrett 10:38

Now semaglutide can be administered orally as well as subcutaneously. I understand it. Most of it, this is a bit explained that the molecule semaglutide as a naturally occurring peptide in our GI tract, it's been manipulated, so it lasts longer. That's how they can give it sub Q every 7 days.

Dr. Phil Gatcha 11:03

Once a week. It's synthetic. So, you can you can change absorption rate and body clearance rate, chemically.

Dr. Barrett 11:11

So, how much does is there difference there from the synthetic version to the national peptide that we make?

Dr. Phil Gatcha 11:20

I couldn't say, Okay, I couldn't say I don't I don't want to venture. I don't want to venture a guess on that one.

Dr. Barrett 11:25

You know why I'm asking you that because anytime we take a natural molecule or a natural peptide, and then manipulate it, it can have different effects, aside from just increasing the dosage effect.

Dr. Phil Gatcha 11:41

Yeah, yeah, we'll go in. I mean, when we talk about the biggest effects I saw with research where the dosage, you know, all the manufacturers give some really good data online, on dosage from ozempic, to Rebelsus to whatever other one there might be. They talked about going low and slow, low and slow, because of the effect on physiology. Also, you know, how fast a human being clears it. Some people are gonna clear this synthetic faster than others. But also, these synthetics have side effects that we gotta be real careful of. So, going low and slow is more protective for the patient. So, you don't have this. Some of the side effects that we'll cover here shortly, because there's some there's some rough ones, nothing too, too awful. But there's some things you got to watch out for.

Dr. Barrett 12:31

Just before you get to your presentation, just a summary of the physiology as I understand it is one it works on the GLP-1 agonist in the gut and its going to cause gastroparesis--it just shuts the motility of the drug or excuse me, it shuts the motility of the gut down. So, you can't you know out a lot of motility, you're not going to digest things as quickly it's going to slow the progression of foods through. And then we have the the hypothalamic effect of maybe some hunger suppression, both types of things. There is a component that I believe where it stimulates the pancreas to upregulate production of insulin. You got that? Right. I mean, we know hyperinsulinemic states, that's not such a good thing. You know, you have to put this all into into perspective, is there any other mechanisms of action that they're, they're thinking about with this drug?

Dr. Phil Gatcha 13:33

Those are, those are the main ones that the GI the GI effects, number one, the hypothalamic effects number two, and yeah, the insulin effect is the third. As we go through, if I kind of it goes through, if more come up, I'll sort of bring them up as we as we go through. But those are the main ones, those are the main ones, we're gonna talk about grehlin. But again, that's the that's the thalamic effect of the hormone ghrelin and satiety and the body's urge to, to crave and to store fat versus not. So, again, that's part of the thalamic effect. We'll dip into some of those things in just a minute here.

Dr. Barrett 14:10

Well, what about you made a great comment about you if you feel like stretched out after that big meal. That in and of itself is pretty much appetite suppressant. You just don't want to put any more food in there. So what do you think's the main physiological effect? They said? They the fact that if we just shut this gut down and make it feel full all the time, is that kind of what you know. All those effects are from that?

Dr. Phil Gatcha 14:42

When I was looking at how this works. I was like, surely there's got to be some like magical transformer magician Merlin effect here and it's simply like, it's really that basic, it seems like effect the GLP one receptor tells the brain we've had enough where full works on the stretch receptors, the central nervous system picks up on that and says, Hey, we're good. Also, let's manage fuel consumption better through insulin. Also, let's not crave more also, let's move things through slowly and again. 80-85%to 93% of people who take this are gonna have a GI effect. Well, no kidding. Yeah, that's you're slowing movement down through the gut.

Dr. Barrett 15:24

Well speaking of GI effects, is there anything you've come across? I'm maybe jumping ahead. So, if I'm jumping ahead to something, hey, just tell me I'll get to that. What about gut microbiome changes? I would think that would be off the charts.

Dr. Phil Gatcha 15:38

Yeah, well, again, the gut microbiome, the critters in your gut, roughly a trillion of them, there's 30,000 to 50,000 different species of bacteria in a given person. Heck, there's nine up to 9000 species of parasites and an average individual. As long as they're all in a harmonious blend. It's all friendly. Opportunistic organisms are the critters that take over when the environment in the gut becomes unbalanced. So, in the other side of my practice, if somebody doesn't digest properly, they're getting unsterilized undigested material in the gut, let throws the environment that got off, and the bacteria begin to react in negative ways and harmful bacteria harmful pathogens rise to the surface and they take control. Well, in this, the bacteria in the gut motility through the gut has roughly 18 hours in an average individual. If you all of a sudden, start slowing that down. Well, the bacteria in your gut are also on shiftwork, the bacteria that were in the morning are different than the bacteria that are in charge at night, less the shifts change, you know, okay, the night shift is used to see in food in there, but, but maybe this material, just sitting there for so long, it'll cause a dysbiosis a bacterial imbalance to occur, the friendly and opportunistic organisms come come out of balance. And that has a host of, of issues with it. Then we just talked about the actual material, like like material not moving through, blockages, things like that, that's those are issues we got to watch out for. We've got to watch out for diarrhea, and when the body sees if there's waste not moving, it'll hyper hydrate the intestines and to flush everything out. So, we're gonna see also, gosh, different yeasts will talk about how yeast is affected. Yeast that might be overgrowing in the body can be affected by this. So, there's a there's some good issues to worry about, or just thinking about this. I mean, as gross as this might be, when food sits there, and we have this drug works really well on you, or you take such a high dose in the gastroparesis the holding of movement from hooter to tooter through the guts slows down. We get people get nauseated, why? Because the stuff ain't moving. They're good people start to vomit. Why? So, guess what? It's coming up. Right? Boy, that seems like a manipulation of physiology that I'm not pleased with again, for a person who could lose 50 pounds. Thank god what a blessing but

Dr. Barrett 18:07

Sometimes you're robbing Peter to pay Paul and you might get a physiological effect that is real desirable. Well, at the same time, you got to get a couple that are undesirable.

Dr. Phil Gatcha 18:19

So, we get the we get the I love them. They're my juicy soccer moms they're lovely. They're lovely the way they are but they fight this battle have never been whatever thin enough good enough. For those people the baggage of this med. I mean, it's flat out works. But the baggage, is it worse that or for the doctor who contacted me whose dad's you know morbidly obese, so we're talking 100 plus pounds overweight, he dropped 60 pounds. Man, I kind of don't care what side effects he deals with. To get that weight off is restorative.

Dr. Barrett 18:52

The benefits are far outweighing the risks?

Dr. Phil Gatcha 18:58

Yeah, by a longshot. And it's, it's beautiful in one case. In another case, it's ill advised. And that's why, you know, when we talk on this, none of this is going to be advice that we're given all this is just data and research. And you got to take each case, one by one, is why I do what I do. I hate cookie cutter medicine, I hate cookie cutter looking at a person and just stamping out. Same, one case after the next, everybody's an individual. And as we go, all this information should be seen that way. You got to take it one by one with your healthcare provider. But these are good data points to just consider and they're all the things with this patient who I love so dearly and all the other ones who've brought this up now in the past several months. I just looked at this data and and I'm gonna share it with you and the audience and and hopefully they could benefit like my folks that some of the folks saw the data and said, I'm gonna go a different route. Some of the folks saw the data and said, beautiful, wonderful worth the risk worth the baggage and it's worked out beautifully. So just kind of teach them and show them what we know. Let people figure it out themselves.

Dr. Barrett 20:02

I think, you know, the more a patient is educated, the more they're empowered actually to co-opt, in their in their outcomes. And if they understand what the drug is doing and a maybe what you need to do, why you're doing this pharmacological modality to optimize? You know that you're gonna get that outcome and probably less side effects.

Dr. Phil Gatcha 20:32

Good. All these folks want is somebody to talk plain English to them, whatever they want. Just give me give me something I can understand and grab on to and don't talk above me. Just get with me, helped me to understand, like, anticipate my questions. You know, be the professional doctor, be the professional but in the same token, man, treat that person like that your mom, your dad, your brother, your sister? And how do they need to hear it so that they can figure out what their best option is? Because at the end of the day, at some point in time, the joy I have like the greatest joy in my life, the best part of my life is what I do with patients. It's the purest part of me. I'm a goofball in most other areas, we'll go play softball tonight, I'm going to be a goofball out there, go play darts, I'll be a goofball. There, I go cut my grass, I'm not that great at that. There's a million things I'm not great at this one area. It's one of the more pure areas and it comes through what you were to my daughter, when you helped for the audience's that doesn't know you're one of the doctors who kept my daughter walking after a nerve issue. And, and, you know, the bottom line is you just loved on us. You treated us with love, you treated us with care. And spoke to us in a way while we were scared and nervous and unsure, you gave us data in a way that we could receive it and make a great decision with it. That's all I care about. That's all I care about these people. And that to me is pure, that's beautiful.

Dr. Barrett 21:47

Well, I've found in my clinical experience, that people are really generally speaking, they're really very smart folks. And if you can, you know if you can translate the medical language to a form of English that they understand they get it, you know, I mean, it's, it's, they're not going to know necessarily what a GLP one agonist is, but and you could tell him, hey, you know, this drug is gonna slow down your gut. So, you're gonna feel fuller, everybody is going to understand that? I think that's part of, you know, the doctoring process has taken that extra time to make sure that that person understands, because usually won't receive so much information that they're overwhelmed.

Dr. Phil Gatcha 22:30

That's a huge problem that I suffer with that but, but when people are left with is what I was left with you. Remember the day we were up, you were performing surgery on my kid, and you came out to talk to us, all I was left with, in that moment of being a puddle of nerves and fear, all I was left with was a feeling of this guy's got it under control, a feeling of love. And then, you know, in the words you said eventually resonated in sunk into this big old brain. But initially, I just needed to know if somebody cared. I just initially I just needed to know. You know, I could if somebody was in my corner, and man, I love that feeling. That's, that's the purest thing I know of. And this is why I love doing we do I love the interactions we've had with you and in what we're about to do with this podcast, so it's kind of cool. So I'm excited.

Dr. Barrett 23:14

Yeah, let's try. Hopefully, the technology Gods will be with us.

Dr. Phil Gatcha 24:13

Alright, so we got this first slide, bullet points, we're gonna we're gonna discuss what's what causes weight gain? What are the consequent consequences of obesity how does semaglutide work for weight loss? What are the side effects? What's the baggage? What helps with long term weight loss? So, the people that don't want semaglutide, or drugs or semi synthetic or the people that have used them, but it's time to come off? What do you do to transition off so you don't have side effects? So, you don't have that big weight gain rebound? And then what are the natural alternatives? What are the things you need to be aware of with this? So, when we look at waking, how profound is the obesity epidemic? Well, first we need we need to know about the body mass index, and it's just basically a measurement of your height versus your weight. It's limited in its application, because certain ethnicities, it doesn't apply to nor does it apply to like the folks who weight lift.

Dr. Barrett 26:14

Yeah, you're a power lifter. BMI is not so indicative of your health status.

Dr. Phil Gatcha 26:23

No, it used to freak me out. But you got to remember I was 270 by 18 years old and playing sports. And I had a waist smaller waist, and I do now and I was told I was morbidly obese, it should have been about 180 pounds. And if you were to look at my family, there's no way there ain't no way. And so sometimes we beat ourselves up with this. But the bottom line is, we start over 25, or over the score, we're overweight, and we get to 30 or more were obese, and they study fives and up. It's dangerous now. So, this is where we sort of like, get the idea of how do we determine what's good or bad? Look at yourself. But if you don't want to just look at yourself, here's the numbers. Now, if I were to ask you a question, what the percentage of people that are dealing with being overweight is and what percentage of people are obese, that will be the next slide. So, in the US obesity rates, and it's the same in UK, Canada, Australia, 69% of adults are overweight then 36% are obese. You know, Africa, Southeast Asia are the only areas on this chart from the World Health Organization in the lower right-hand side. They're the only places where we're not seeing this. So, we're seeing more industrialized places on the planet. We're seeing access to more processed foods. And the tough thing about this is we're gonna go into some of the causes. Why do people gain weight, why are they obese? And I want everybody who's viewing to not feel singled out. As a guy who no matter how hard I work, you know, I would love to know what it's like to walk on your body. My older brother. He's my height. He called me about a year ago, with a trainer taking high calorie, not protein, just calorie drinks. He finally achieved a weight of 160. Dr. Barrett, I was 160 by think 12 or 11. Right. And so, you know why I don't want to feel singled out. It's a lot of people going through it. But you're not alone. But let's confront it. So, let's go through some things. So what do we see with weight gain. Genetics.  If you came from my area of the world, where my great grandparents came from being starved in the country, they came from come into America, they got moved into the coal mines, my grandfather on one meal a day was still a six foot five 260-pound man. Now he died in the coal mines, which stunk and bad thing for my family. My own dad was a division one scholarship athlete, doggone guy was about 280 pounds in 1959. And, like a rare he was a rarity. That's the guy who didn't get many meals. So, there's some genetics that play a role. So, there's 40 to 70% heritability. And when we look at heritability, you know, we want you to think genetics. But again, genetics, you've heard this analogy, I'm sure your body your gun, so to speak, is loaded with your genetic bullets, whether you pull the trigger or not, is up to you. So, if it's nature versus nurture, you might have the genetics to be a big old person. But it's going to take some decisions that to get you to to express a negative or harmful physiologic expression of those genetics so there's only a couple of genetic traits that we that have 100% expression 100% heritability, the rest we do have a say and so the goal, I don't know I'm never going to be perfect, but I'm sure as heck going to try and that's all we're asking from people here. Now. When we look at the next one socio economic, there's food deserts, places where there's lack of access to healthy food, there's a high cost of getting good food. There's gas stations I go in when I travel to see our parents go to gas stations and it's more expensive to get fresh fruit than it is to get, you know, three roller dogs that have been sitting there for, I don't know, the last eight hours. So that's an issue, the convenience store food, it's the high cost to good food, highly processed food is cheap. What the more processed food we put in our bodies, the more problems we're going to have, it does not agree with physiology. The next one, lack of exercise, lack of movement. Some places people don't have access to safety, places where they can feel safe getting exercise, or to go to a gym, or whatever it might be. They're just not getting access. And then we look at, you know, poor diet in terms of like just choices. Again, we're touching back on processed foods. We're touching back on the things people like food right now. So hyper palatable, calorie rich, that you would rather have a bag of Doritos over a salad. And on the salad, you get full in the bag of Doritos--It's almost like a never ending, you just keep having them. So industrialized food, loaded with calories processed. It really hit us heavy in the 70s. And it's no, it's no slight coincidence that obesity has gone up three times since the 70s. So that's an important thing. Next one, lack of exercise, lack of movement, we live in a driving culture, not a walking culture. And so we're looking at whether people just don't have the time to exercise. Because of the work life--balance, we don't have any more, or there's no motivation. I see so many people there, they're just locked in just locked in the inability to get moving. And it becomes self-fulfilling and they keep on going no movement and therefore the weight packs on. Next, we look at depression. In the human brain, dopamine, dopamine is associated with reward. Well, all these hyper palatable foods, stimulate the reward sense centers. Then we look at serotonin. We live out in the woods and I have, I have a couple of hunting dogs out there that are that we get coyotes that come through. And if a siren goes through, the coyotes howl at my dog's house. So, it's kind of crazy over here right now. Thank goodness, you're not picking it up. So, dopamine is your reward center foods stimulate that, then there's serotonin. When serotonin is low, you're going to overeat why serotonin, the chemical your brain makes to feel happy. Well, when you're low on it, you get grumpy when you're really low on it, you get depressed in the body sees that low serotonin is some sort of threat to survival. So, the what the body does, under threats to survival, and it puts up your antenna, you get more aggressive you state you try to get away from danger, but also, you usually start packing in calories. Body fat, is survival in the future low serotonin says I need to survive in the future. Next relationship with food. So, it's cultural, mental stress, there's cravings or different impulses. If you come from where I come from Ukrainian Hungarian Polish type background, the foods that those people the immigrants had access to were very cheap, very, very fat rich. And they learned how to cook really good tasting food with very little resources. It's the same for many, many other cultures. And so as we grow and learn, hey, I don't need to be eating meat, and carbs and oils and sugars packed one on top of the other and highly processed. You know, you shouldn't. But grandma gave it to me and mom gave it to me, and it comforts me and I love it. I don't want to depart from it. So, that's a big one. Right? hormone issues are well, also with that relationship to food. We talked about cravings and impulses, you get people I don't want to miss this. Whether it's eating disorders, whether it's people who binge eat those people out there who are like me, we're serotonin by the end of the end of the day's low, and you get that big urge to night eat. Then there's folks who do unfortunately, with bulimia, those type of cravings and impulses, that is a crazy relationship to food that really throws people off hormone issues. So, whether you're a person with a high, a hypo, low functioning thyroid, or you're a person who's got Cushing's when we look at the obese population, 10% of them 9 to 10% of the research actually have Cushing's. So, it's, it's an issue that could be and should be controlled with an endocrinologist. So, it ain't your fault at all. It's not that you're a bad person and doing wrong. You just have a have a breakdown. Or what about people with hormone issues? We talk about a woman on birth control. Those hormone issues with estrogen can affect weight. What about the man who's getting the Manboobs? He's aromatizing testosterone converted to estrogen, that person is gonna have an issue. What about the woman who's peri-menopausal? There's all these what ifs? Well, hormones play a big role. Then there's drug side effects. So different medications. that used to control weight, or different medications like for instance, antidepressants, birth control, anti-psychotics, anticonvulsant, steroids. There's the list there. All these things, all these medications, increase weight gain. With that in writing there, you better consult with your doctors don't just listen to something like this and jump off of it, but pay attention. There's a medication link to why some people hold on to weight. Make sense? We could.

Dr. Barrett 35:28

Absolutely. And I think I think still the important thing to me, but the non-physician audience to understand is that all of these things are interrelated. They're not. I mean, if you have, if you have depression, and you have a hormonal issue, other they're inextricably woven together, and you can't just treat one without affecting the other side. Now there's a lot interrelationship play going on.

Dr. Phil Gatcha 35:53

Yeah, yeah. And then you go to the consequences. They're pretty clear. Yep. cardiometabolic risk. So that's stroke, that's heart attack, risk to the liver, risk to the gallbladder, type two diabetes, risk of depression, sleep apnea, gastro esophageal reflux, disease, GERD, infertility issues, we've got joint breakdown inflammation throughout the body, when we're holding weight that we shouldn't be holding, it really has a tremendous impact, and something that we really want to make sure we're doing our best to deal with. So then enter semaglutides, and they, they work, they work. It was a medication designed originally for diabetes, found to be very useful for weight loss approved for weight loss. But there's the ones that were talking about earlier, glucagon, like peptide number one. So GLP number one hormone that's made by your body for you, after you eat, and it fills a receptor site that tells the brain you're not hungry anymore. Well, semaglutide is a chemically altered synthetic version, and it fills it takes the parking spot for that GLP one receptor. And what it will do is, have all the effects of telling the brain you're not hungry, improving blood sugar balance, and slowing movement of food through the gut so that you don't have this urge to keep on eating. And so, with that being the case, the body begins to dip into its reserves and you lose weight in it is really, really effective. We look further. Here's what you're asking about before. So, what are the main mechanisms? Well, here they are, slows down the food with leaving the stomach, so you feel full, you feel full longer in the brain the hypothalamic region, the brain to tell the brain to decrease, decrease hunger and decrease cravings. And they will increase your insulin secretion after food intake and insulin. For the for the uninitiated, is sort of a taxicab a hormone that tells the nutrients the energy that you've consumed that you call food, it tells it what to do tells it where to go. Again, like Dr. Barrett mentioned earlier, when you have too much of it, it can cause some issues because insulin resistance is a big problem in our country right now.

Dr. Barrett 38:02

Is anybody really looking at what serum fasting insulin is doing through the progression of the treatment or the therapy with semaglutide?

Dr. Phil Gatcha 38:24

Love it. So, the doctor who originally got me to look at this for their father, they said semaglutides don't require lab testing. Which ones would you take? I said, Well, let me see fasting tests. Let me see what's happening with insulin. Let me see what's happening with blood sugar, the A1C. And so, before I would have somebody who I love on us, I'd want a blood test to check I'm going to give go through what I would actually ask to be tested. But then I would also for people who are diabetic, they've got to have that blood sugar, the A1C and the insulin monitored throughout. Because as this drug works, the body is going to need there, the doctor is going to need to change medication and really guide that patients so that they don't have a really, really harmful effect of hypoglycemia that you know, hypoglycemic episode.

Dr. Barrett 39:12

Here's one thing that depresses me when I see a lot of patients that are diabetic and they're being managed, no one's looking at anything but maybe they're fasting glucose and their A1C and they're not taking the time to actually get a serum fasting insulin, which was a very inexpensive test and can be done very easily and with the same blood draw, but a lot of times these people will come in and their A1C has come down nicely, but they may have a 30 for serum fasting insulin was off the charts. And so, you have to kind of look at these things to figure out well, is there some balance here because we know you know, a hyperinsulinemic state is not optimal for peripheral nerves. We know that and it's not optimal for cardiovascular. And so again, that's one of those things that I would love to see monitored.

Dr. Phil Gatcha 40:08

Yeah. Are you managing numbers on lab or certain numbers you want to look at? Are you managing a human being for their own for the best? That's what I hear when I hear that from you. And, you know, when you when you look, I want to I want to drop back real quick. When we looked at the semaglutides, there's about five other medications that have been approved. Prescription meds have been approved for weight loss. Some people will recall phentermine. That's appetite suppressant, some people are going to think about there's one called Bupropion It's an antidepressant effects weight loss. Naltrexone appetite suppressant, and it's an insulin sensitizer brings blood sugar down. And there's something called orlistat lipase inhibitor, so stops body fat absorption. liraglutide, this is semaglutide, sort of ugly cousin. It's the same, it's a GLP, one agonist like semaglutide is, but semaglutide works better, and it's cheaper. So liraglutide got totally passed off, which be a guy that worked in pharmaceuticals for a period of time, you know, the company that did liraglutide work is like, kicking themselves because they didn't jump on semaglutide. fast enough. But liraglutide works, but not as well as semaglutide. And not as effective, as far as costs. So, you know, part of the deal. And again, when we look at the results of semaglutide, you can't really mess with it. Again, how long is the person on the drug, how much weight do they need to lose, and how much weight can be lost in a healthy weight, that all matters, and the results vary, but most people lose about 5% of body weight. So we're using a 250 pound person as the example. So on the screen, most people 5% expect 12 and a half pounds, that's a big change. People, everybody wants more. So a third of the people lose about 20% of their body weight. So that's a 250 pound person losing 50 pounds. And when you look at diet, and exercise alone, if you were just do diet and exercise, five to 10% of body weight loss. So, I mean, this is a huge, huge step forward for people. We had going further I looked at some research. When you look at these folks, there's about 13% of people who will do this modality, this drug, and they're gonna see no change whatsoever.

Dr. Barrett 42:42

What was that percentage to 13?

Dr. Phil Gatcha 42:45

Yeah, roughly 13. When you when you look at 5% of weight loss has occurred, here's the research, the roughly 5% of weight loss, so the 12 and a half pounds lost, that's occurred in about 86 to 88% of people. So, we just rounded off. So, 13% of people. So, 88 87% of people got help. What about the 30%, who took it and didn't, those people oftentimes still have a bad diet, so you can't out drug about diet, in most cases, right? The people who got about 10% of weight loss, so let's use this 250-pound person 25-pound weight loss, that that occurred in about 70, anywhere from 70 to 69.1 to 79% of people, people got 15% weight loss, that was a 250 pound person losing about 40 pounds, that happened in 50 to 63% of people. And then once again, this 20% weight loss 50 pounds off of a 250-pound person that occurred and 32 to 40% of people. So Holy cow, this thing works. I mean, you can't, you know, those numbers are strong, you can't you can't deny that. So, again, if you still have, if you get the weight off, it's going to want to come back on. So, what's the underlying cause? You'd better be looking at that we're gonna get to some of the underlying causes in a second. So, when this doctor came to me, all those years, not those years ago, all those months ago and said, Hey, what about my dad? First thing I looked at was the research that said, Okay, who? Who is this drug contraindicated to indicate it for so we'll look at side effects in a second. But who it's contraindicated for? Other people with multiple endocrine neoplasia, type two, so genetic condition where you get endocrine tumors, not for you. What about a person with a family history or personal history of medullary thyroid carcinoma? This, there really worried about this, there were rodent studies done. And the GLP one receptor in the gut, in written rodent models, was also found in the thyroid gland. And so, based on the rodent models, there was this increased incidence of the medullary thyroid cancer. So, if you fit into that category, it's not for you. Sensitivity to medications. What's kind of like a no duh. If you try it and it doesn't, it makes you feel bad or you react, you shouldn't use it. Then the last one is pregnancy. Although in the drug manuals, it says it's safe for breastfeeding, quote unquote safe for breastfeeding, let's start with pregnancy shouldn't do it during pregnancy. Why? Because during pregnancy, your need to gain the weight to have the baby. And if during pregnancy, you aren't are doing something slows down digestion, guess what you're going to do, you could miss nutrients for your own body and for the baby. That's number one. Number two, if you're slowing down nutrient absorption, what are you gonna have, you're gonna have fat loss. And if you have fat loss, what's going to happen? Well, we touched on this earlier, toxins are locked up in fat. The human body makes fat when you have extra food, but the human body will also make fat. If you're in a, if you're in a toxic environment, certain toxins are fat philic, they like to be stored in fat in the body will create fat and some people in order to have a reservoir to store toxins. So now you're a mom growing a baby. And all of a sudden, you want to do what you want to drop some body fat. And those toxins are now released into general circulation that that could get to your baby, not not good. Now. That's what made me start looking at this is considered, quote unquote, safe for breastfeeding. And, again, breast milk is highly loaded with fat, right. And if somebody was taking this, you know, the the, you're gonna put a lot of toxins into the system. One thing we found one doctor looked at their research, they have women who are breastfeeding that wanted to do this, do it while they did a, what's called a phase one, phase two, liver detox, and there's some logic to that, I would just probably hold off again, your nutrition for the baby, this drug may stop you from getting enough nutrition and therefore the baby as well. Also, the fat-soluble toxins can get to the baby. And again, since breast milk is so rich and fat, don't want to pass anything along. So, kind of a good idea to maybe hold off on that.

Dr. Barrett 46:46

I have a question for you go on, because I think you're making a great point here, if you have these toxins that are sequestered in the adipose tissues, such as Heavy Metals that love to hang on to this fat, and then we we break this fat up with this drug. And now we have this release of toxins. Are there any Herxheimer reactions seen?

Dr. Phil Gatcha 47:13

If you're in what's called your so the way wastes leave the body is there's something called the phase one, phase two, hepatobiliary tract pathway. So, toxins locked up inside of cells are spit out into the blood and lymphatic system, those toxins should be made, it should be picked up by trash trucks, antioxidants, those trash trucks should unload that material at the liver, the liver should process the waste with bile into the gut, the gut should then expel the waste into the toilet. But if you have a roadblock in any of those places, then you may get retox. So, the cells dump waste into the bloodstream. They're now floating around the bloodstream to redeposit themselves in some other area. And very commonly, it's the brains of the people who went to Whole Foods and did the whole foods detox that's like, over the counter. So, it can't be that aggressive. Or you take that person, if they're highly toxic, and they do any kind of detox and waste is now released into their system. They're gonna have horrible reactions, because that waste is now being pumped by the heart to the whole body. where's it gonna go? Well, not only is it gonna go to other organs, but the brain is the big one. Right? So, they'll get headaches, they'll feel horrible and say, Oh, I'll never detox again. Well, no, you need to detox. You go to the bathroom. Every day you're detoxing. You just did it in the wrong form the wrong fashion in the wrong order. So, we'll cover that in a second. What do we need to do to make sure the body can grab heavy metals, or hormones or food out of this? Nature gave you the good Lord gave you six pathways, that if these things are working is one of my pet peeves. Patients come to me and they say, I saw Dr. Online. He is a heavy metal detox specialist. bullcrap. I saw Dr. Online, they're a hormone specialist bullcrap, you have the six pathways that get rid of those wastes, they either work or they don't. So you can you can have a guru that sells you on I'm gonna get this pathway or that pathway working. And we're gonna get this keyword, this niche of hormones or this niche of toxins and heavy metals. It doesn't matter. These pathways either work or they don't.

Dr. Barrett 49:15

What about, you know, outside of those pathways, so using things like EDTA chelation agents, things like that, activated charcoal?

Dr. Phil Gatcha 49:28

Where does it work, though activated charcoal works in the gut,

Dr. Barrett  49:30

Right?

Dr. Phil Gatcha  49:31

The pathways are glutathione, conjugation, sulfation, methylation, glucoronidation. There's one more I'm missing. But these pathways if they don't work, those materials have to be taken from the blood and lymphatic system to the liver, from the liver to the gut. And then once those things get in the gut, extra fiber and chelators some chelators get to the blood, but those like the charcoal and those things, they worked beautifully. They worked beautifully. We've got to get it there first. And most people, when I do bloodwork, we're seeing liver enzymes we're seeing we're seeing inefficient liver function. And it's not because the person's beating themselves up or abusing themselves with alcohol or, or chemistry, it's that we live in a world that's really toxic.  And so, our air and our water and our food no matter what, it's not as safe as we need it to be. And so, I remember I remember being an almost paralyzed with my three kids, especially my oldest daughter, who, again, you've loved on taking care of my goodness, I remember looking at and saying, Gosh, I can't wrap her in a bubble. everywhere she goes, she's exposed to toxins. And then we realized, well, the goal isn't to bubble wrap her, that's the worst thing I could do. But my goal became make her hard to kill a little bit aggressive, but like, before systems up, so that she's, uh, she's capable of taking on all comers. And it turns out that all the really nasty things, toxins that are introduced in our environment, It's sickening, but your body was equipped. If you give it what it needs. It's really well equipped to cope and to deal with a good many of them. Now. Anybody's physiology can be overwhelmed, but we've got, we've got capacity and capability and we darn sure better access that capability to detox when we're getting rid of fat tissue that could be dumping toxins into our system. So, if you're taking these drugs and you're getting the headaches and you're getting fevers and getting achy joints, man, take a look. Are you dumping toxicity into your system as you break down fat tissue?