Semaglutide Weight Loss Plan

Weight management and weight loss has long been a challenging area of medicine. Recently, Semaglutide and other incretin medications have emerged as game-changers in the field of weight loss.

During BodySite’s webinar on Wednesday, June 28 at 12 p.m. EDT, Katrina, VP of Operations of BodySite shared about BodySite’s new Semaglutide Weight Loss plan. The plan is a 10-week support program that helps you provide additional value and support to patients who are using Semaglutide. The plan includes education about Semaglutide and the benefits, healthy recipe ideas that may help to improve patient results and maintenance after use of the drug, general health/wellness tips for overall well-being and a weekly task for taking the injection and tracking weight to increase compliance. The daily breakfast, lunch and dinner recipes are lower in fat, with lean proteins (including plant-based proteins) that incorporate whole grains, fruits and vegetables, somewhat reflective of a Paleo/Anti-Inflammatory diet approach. The recipes are mostly gluten-free as there are only three recipes on the plan that use gluten, of which all three state a disclaimer that if doing gluten-free to use a gluten free alternative.

In addition to the information provided about BodySite’s new Semaglutide Weight Loss plan, Dr. William Clearfield, D.O., F.A.F.R.M, F.A.A.M.A, D.A.B.M.A., client of BodySite and weight loss/hormone expert, shared about the “New Face of Weight Loss.”

Dr. Clearfield walked participants through the history of dieting, how we got here, the problem of obesity, nutritional plans determined to be most helpful in restoring homeostasis and weight control, and the latest incretin medications used for weight control, including semaglutide. Dr. Clearfield shared about things to do before using semaglutide with patients, side effects and ways to improve patient results beyond the use of the drug. As Dr. Clearfield discussed, not changing one’s diet will increase side effects associated with the drug, so it’s important to tell patients to implement both diet and lifestyle change. BodySite’s Semaglutide Weight Loss plan is great for increased compliance, education and provides healthy recipe ideas for patients that may help to limit side effects and improve outcomes.

You can watch the entire webinar recording below:

During the webinar, Dr. Clearfield also shared about the Mind-Body Connection and his 8 Weekly Steps to Achieve Optimal Health. You can get access to his handout by clicking this link. If you would like to get in touch with Dr. Clearfield, his email address is doctrbil9@gmail.com.

Dr. William Clearfield, a graduate of LaSalle College and the College of Osteopathic Medicine and Surgery, Des Moines, IA., completed a rotating internship and served as an OB/GYN resident at Metropolitan Hospital, Philadelphia, PA. Certified by the American Board of Family Medicine after completing a Family Practice resident in 1982 at United Health and Hospital Services in Kingston, PA, Dr. Clearfield, since 1982, has been a lead figure in family and integrative medicine. With graduate expertise in areas ranging from Cardiac Rehabilitation (the University of Wisconsin/Lacrosse) to Medical Acupuncture (UCLA, 1991), to Age Management and Non-Surgical Aesthetic Medicine (Fellowship trained and Diplomat status from the American Academy of Anti-Aging Medicine,) Dr. Clearfield, a leading authority on cutting-edge medicine is a prolific and popular speaker regularly addressing the Age Management Medical Group, the American Academy of Anti-Aging Medicine, OMED, the American Osteopathic Association’s Scientific Convention, the Nevada Osteopathic Association, the American Osteopathic Society of Rheumatologic Disease, SVYASA University in Bengaluru, India, and the Second through Eighth Annual Global Webinars on Traditional and Alternative Medicine. Dr. Clearfield is one of three Nevada representatives to the American Osteopathic Association’s House of Delegates and is the Executive Director of both the American Osteopathic Society of Rheumatic Diseases and the American Osteopathic Society of Integrative Medicine.

If you’re not already using BodySite in your practice or company, take advantage of our 30-day free trial, included with any of our pricing tiers! Note: all pricing tiers include access to the Semaglutide plan. There is no additional cost associated with use of this plan.

In case you want to read about the Semaglutide for Weight Loss Webinar, here’s the full transcript:

Thank you all for joining us for the new face of weight loss webinar.

My name is Katrina. I’m VP of Operations here at Body Site. And with me today, I have doctor Clearfield, a wonderful doctor, and client of body sites.

So just a little summary of the agenda today. We have some housekeeping items to cover.

I will be covering body sites new some of Glutide program. I’ll pass it over to Dr. Clearfield for his great presentation that he’s prepared for us. And then we’ll go into a brief q and a session.

Regarding questions, as you have questions throughout presentation today, whether they’re related to body sites, semaglutide plan, any questions about semaglutide that doctor Clearfield might be able to speak into. Or questions about anything he covers in his presentation.

Go ahead and send those in the chat box, and then we will cover those at the end during the q and a session.

Alright. So as many of you probably know, we have our new semaglutide weight loss plan. This plan is a ten week support program that is really used to help you provide additional value and support to your patients who are using semaglutide.

This program includes education about semaglutide, the benefits, It has an how how to video, has healthy recipe ideas, tasks, increase, compliance, and general health and wellness tips.

So, basically, the overall plan details of this new program. Number one, like I mentioned, it’s ten weeks in length.

This plan, just like all body site plans, are fully customizable. So if you wanted to change out the video on day one. If you wanted to add your own personal touch to it, you can customize anything about this program.

Includes a weekly task for administering the injection as well as a weekly task for tracking weight.

As I mentioned, there are daily general health and wellness tips for overall well-being.

As well as daily breakfast, lunch, and dinner recipe ideas.

These recipes are lower in fat with lean proteins, including plant based protein options that incorporate whole grains, fruit, and vegetables.

I would say the overall diet approach is that of a paleo or anti inflammatory like approach.

Option, as some people have asked about this, the plan can be paired with an exercise or movement program such as body sites at home fitness plan, the new hiit plan, or even just a basic walking plan.

We understand that everyone kind of at different levels, so we’ve intentionally not put a specific exercise program into this program Instead, you would basically put your patient on the semaglutide program as well as the exercise or movement program. And it’s very easy to toggle between plans in both the web platform as well as the mobile app.

Awesome. As I mentioned earlier, we have with today, Dr. William Clearfield.

He is a graduate of LaSau College and the College of osteopathic medicine and surgery. Completed a rotating internship and served as an OB GYN resident at the Metropolitan Hospital, certified by the American Board of Family Medicine after completing a family practice residence in nineteen eighty two at United Health and Hospital Services in Kingston, PA.

Doctor Clearfield since nineteen eighty two has been a lead figure in family and integrative medicine.

With graduate expertise in areas ranging from rehabilitation to age movement and nonsurgical aesthetic medicine, doctor Clearfield, a leading authority on cutting edge medicine as a prolific and popular speaker, regularly addressing the Age Management Medical Group, the American Academy of Anti OMED, the American osteopathic Association’s Scientific Convention among others.

So thank you doctor Clearfield for being here with us today.

We’re so grateful for your expertise. So I’m gonna pass it off to you to share with the group. Okay. Thank you.

So I’m assuming most everybody here is a body site and the customer resident correct me if I’m wrong.

Looking at it, it’s kind of like a mix I think we have some body site subscribers, some none, but most should at least be somewhat familiar. So gonna be eluding a lot to body site.

I was maybe one of your first customers. I’ve been with you. However long you’ve been, I think at least ten years Yeah. Way back when when I think you had three plans in there, MCD or something, And if you’re new to body site, it’s really a great tool. We use it every single day and it saves me a lot of time it saved me from having to, we do have a nutritionist that we hire out from hiring an in service, an in house nutritionist, We made our own programs and if you’re new to it get familiar with it and it really is something that I always wanted to do on my own. So just a little bit of background. In nineteen eighty four, way back at the dark ages, on an Apple 2C computer, if you remember those, you probably don’t remember that Katrina number.

It had a five and a quarter inch floppy disk and one hundred and twenty eight k of RAM, we actually wrote a diet program for individuals and we would put their name in, their height and their weight, that would give us recipes and menus for a week. And it was kind of crude, but it was it was a big hit and I was actually on the news back where I was in Pennsylvania and it was something of a sensation. I was never able to put it together the way you guys have, and I’m really happy.

We’ve been really happy with the whole thing. So today’s topic This talk actually came out of something that I did at AMMG in April, the new face of weight loss.

Since we wanna concentrate on semaglutide. And what I’m gonna I’m gonna change it a little bit and I talked to you about this yesterday. I’m gonna call it the incretions because there’s more than one now. So my glutide was the first one that was released, but there’s two, and I’m going to show you actually a third one with up to the minute information stuff information that was published on Monday about one of the ingredients.

So we’re going to — that will be our emphasis, but we’re going to look at an overall view of dieting, how we handle it, at least in our practice, We’ll go over some diet overviews. I’m not gonna go into any details.

We’ll talk about semi blue tide and tepirazide, which are the FDA approved substances that are available although tepirazide is not FDA approved for weight loss at the moment, but it’s coming.

And we will talk about some other interventions that we do. We’ll talk about complications, how to handle the complications, and we’re going to talk a little bit about maintenance also. There’s a big big thing going, well you’re going to gain two thirds there was a study out just recently, two thirds of the weight gain the weight is regained. Once the patients stop the medication.

So we’ll talk about how to get around that also. With also something fairly fairly new. So this was a CME lecture or part of it was it’s a little bit different than what we did at AMMG. So we don’t really have anything to disclose.

We’re going to talk about a brief history of diets. I shortened this down. I like doing this first because what it does What it does is it shows that everything old is new again.

And I’m going to show you two diet plans that were developed in the 1800s, and you won’t believe I didn’t believe it at first. And I thought this was a great thing to show show everybody. How did we get here? Up to seventy percent of the U.

S. Population is now considered obese in some counties. We’ll talk about the four pillars of weight loss. And again, we’re going to talk about interventions.

Mostly, that’s the topic for today. But we’ll talk a little bit about the evaluation, the practitioner interventions, and we’ll give you some tips and tricks. So So where to begin. So there’s a lot of confusion with diets. This was Time Magazine over here on the left in nineteen eighty four. Cholesterol was bad. Twenty fourteen cholesterol was good.

And as anybody who’s worked with overweight issues and obesity.

You know, the misinformation is as long as your arm. You know, what’s so great about kale? Well, red meat kill me one week coffee’s good for you, another week coffee’s bad for you.

High fat diets are out, high fat diets are in. High sugar diets are out. High sugar diets, well, maybe it’s not so bad. It’ll only rot your teeth out.

So we’ll try to dispel a couple of those myths. So I’m gonna start here. In eighteen twenty five, believe it or not, this fellow was Jean. He was French John and Phil Brilliant, and he was a chef.

He was also a politician, but he was a chef. And he wrote this book called The Physiology of Taste and it was one of the early sort of pamphlets And what he said was that carnivorous animals never grow fat and herbivorous apples do not grow fat easily until they age. With reduced inactivity.

They fat and quickly as soon as they are fed on potatoes, grains, or any kind of flour. Does that sound familiar?

The chief causes obesity as flourly and starchy substances, which man makes the prime ingredients of his daily nourishment.

And all animals that live when faretionist food grow fat, willy, lily, and man is no exception to the universal law. So he’s advocating a high fat low carbohydrate diet in eighteen twenty five.

So that was — he was a Frenchman. This young man was a funeral director in the eighteen sixties in London. This was his picture of him on he wrote this, it was called the letter on Corpus in eighteen sixty two, and this is actually believe it or not, the same man in eighteen sixty nine. And he stated of all the parasites that affect humanity, I do not know of nor can I imagine any more distressing than that of obesity?

He could not stoop the tie his shoes nor could he attend humanity’s offices of humanity without considerable pain. He had to go down backwards from stairs to save the jar up weight increased upon his ankles and knee joints, and he was obligated to puff and blow with every slight exertion particularly going up the steps.

He had no bill of fare or he had no road map to know what was really intended.

And he brought himself into a low impoverished state by following the guidelines of the day. He had many obnoxious boils appear in two rather formidable carbuncles which he had to be operated on. He was then fed into increased obesity.

So his cure for corpulence, he cut down from four meals to three.

He recommended vegetables of all kinds from above the ground except peas, fruit was less likely to increase weight if it was cooked without sugar. Fat was to be skimmed off of gravies and jellies, and if expressly prohibited, bread, milk, butter, beer, sugar, and potatoes, and all root crops, including carrots, turnip, parsnips, swede, and beet root.

This was his daily breakdown.

This was for breakfast lunch dinner, tea and supper. And he had seventeen hundred calories on average, one hundred and fifteen from protein, twenty two percent forty two calories from fat, one hundred and nineteen from carbohydrates, But this was the big controversy of the day. Only twenty three percent of his calories were allowed to come from alcohol. And for this, he was announced actually in the in the British parliament for being, you know, sort of a heretic.

So again, this was eighteen sixty two, fast forward one hundred years, nineteen seventy two, atkins and then this in the beginnings of the low fat craze.

It stated that it was low fat diets and high fat diets in and low carbohydrates were the keys were the keys to a healthy body. So again, The point being is that there’s nothing new under the sun. These are obesity trends. This was from the US Department of Agriculture.

In the nineteen ninety, which was thirty years ago.

The light blue is less than ten percent the darker blues were ten to fourteen percent of the population in nineteen ninety, Those of you don’t know, I live in Nevada, which is here, which was white, which they didn’t bother.

So in two thousand most of the country most of the western part of the country was at fifteen percent to nineteen percent and the middle of the country twenty to twenty four percent. By twenty ten, it was even worse, greater than thirty percent especially here in the sort of the bible belt.

And here, this was a different colored graph but in the darker reds here were up to forty percent and fifty percent So you can see the trends from ten to fifteen percent of the population to more than half of the population.

So what happened? So every cardiologist that you talk to will say the patient’s cholesterol should be zero. I mean, I’ve heard that. They wanted the LDL less than seventy. And fat, you know, fat is your enemy.

You know, when we point out to them that the brain is sixty percent cholesterol, they don’t want to hear it. So it’s a kind of a constant tug of war. So the low fat, high carbohydrate diets took hold in the early 80s to late 80s and within five years of the medical community’s acceptance of low fat diets, Of course, we’ve developed the health crisis. So the US Department of Agriculture, those of us of a certain age, you can tell by my hair It’s silver by the way that I’ve been doing this for a while.

This was the USDA’s food pyramid. And at the bottom was six to eleven servings of bread, rice, cereals, and pastas. And at the top, you know, a little bit of fat, maybe meat and poultry here, two to three servings, milk yogurt, cheeses over here also two to three and vegetables somewhere in between. Remember, vegetables even though they’re most of them are good carbohydrates and fruits are still carbohydrates.

Fruits as you know sometimes contain a lot of sugar And our rule of thumb for that, I didn’t go because I didn’t have time didn’t go into the glycemic index here, but fruits that are watery. If you bite into them and you get all wet and slop and you need to clean yourself up like melons, oranges, those kinds of things. Those are high in sugar.

The moderate glycemic index fruits are the ones that have a little bit of water. So we’re talking maybe apples and oranges, even pears, and the berries seem to be the best.

The bunch. So what happened?

You know, we did it. Our doctors did it.

You know, we we started this dumpster fire. And right here, this is where the low fat craze began and about fifteen percent of the US population was obese in nineteen eighty five, And by the twenty ten, two thousand and six, it was up to forty percent to fifty percent And I’ve seen in some areas over seventy percent So So just like the Hashimoto’s autoimmune thyroid crisis that we fostered in the late 40s and early 50s, it’s really on us. We did this because we thought we knew better. So what are we going to do about it? So in our group, what we do is we look at what we call the four pillars of sort of a healthy lifestyle and weight loss. So we’re going to look at some nutrition. We’re going to just do a little bit those of us that are a little bit more mature, especially as well I’ll talk for myself, I really had a difficult time with this concept chronic inflammation as being the root cause of all disease.

So we’ll talk a little bit about that. I’ll give you short analogy, hormone restoration is vital. Our practice is mainly focused on hormone optimization and that’s a whole year’s course.

I’ll provide you with a little chart that’ll tell you which hormones what each hormone does. There’s actually some doses in there and what to look for with deficiencies, but that’s really not the focus here. And I sent to Katrina and if anybody wants it, we do have a mind body program. It’s an eight week program that we use with our diet program.

It’s pretty much a handout checklist. The patients fill it out at home and they bring it in and we’ll go over it. And if anybody wants that, you’re more than welcome to have it. It’s eight weeks of of sort of mental and mental exercises, really.

So nutrition. So the standard American diet creates inflammation.

I think we all agree on that. There’s no no question about that.

We take in too much fat, results in chronic inflammation and insulin resistance, We also eat too much salt and sugar. And the aforementioned autoimmune crisis when the US government decreed that they were going to take iodine out of the food supply because it had been determined erroneously that it was a poison and also at the same time fluoride was put in the water supply in nineteen forty seven and sixty major US cities. It took five years for the autoimmune insufficientencies to show up in a major way.

And so, of course, they realized they had made a mistake and even then, politicians don’t ever they never make mistakes. So what they did was they stealthily decided what do Americans eat too much of? It came down to salt and sugar, so they decided on salt. So that’s where iodide salt comes from, actually. So we iodized salt so to try and put the iodine back and the food supply that had been taken out, and it was hailed as a great breakthrough. But but that’s a story for another day. So chronic inflammation, insulin resistance, results in increased triglycerides, blood sugars, abnormal cholesterals at increased blood pressures, waist size, sleep apnea, and it leads to all sorts chronic diseases that you see down there at the bottom of that pyramid.

This is a chart just of sort of some popular diets that came about in the aftermath of low fat high carbohydrate craze.

And the one that became the most popular was the ornish diet, Dean Ornish was a physician in I think at UCLA.

Now I was living in very p eight, and he came actually to the biggest theater there that was like a big show and he put on a he had a three thousand people show up in an indoor theater and very PA, which is not that big a city, and he advocated a seventy percent to eighty percent carbohydrate diet, less than ten percent fat, if anybody’s ever tried that, it’s pretty difficult and twenty percent protein.

And this was hailed as the new normal.

Didn’t quite work out all that way. Earlier there had been the Mediterranean diet was actually written about in the New England Journal Medicine in the 1960s, and that’s pretty much a balanced forty percent carbohydrate, forty percent fat twenty percent protein. It’s pretty close to the paleo diet. It’s almost the same. And the zone diet was another just a little bit of slight alteration.

The ketogenic diet is a high fat diet with about twenty percent protein and just about five percent or ten percent carbohydrates.

And atkins Robert Atkins was a physician in New York City, he had written the Atkins diet in nineteen seventy two. He was actually subpoenaed in front of Congress to explain himself and he was determined it was decree that his methods were medically medical suicide, quote unquote.

He made a resurgence again in the late 90s after, you know, it became pretty clear what happened you know, the the low fat the low fat diets.

So what do we do with this? So we’re going to measure. We like to do some measurements.

So we look at blood sugars, of course, and we look at blood sugars three different ways.

So we look at it and I liken it to the Christmas Carol. We’re going to look at blood sugars of the past present and future like gonna look at the, you know, Christmas of past present and future. So the past is actually going to come next. With the fasting blood sugar, we consider that the present. Now when I was an intern, way back in the dark ages, at Metropolitan Hospital in Philadelphia, which is actually now a condominium. It’s not even a hospital anymore, but The patients would come in if they were diabetic. As long as their blood sugar was under two hundred, that was considered acceptable, a fasting blood sugar.

It then was kind of standardized at one hundred and twenty five, and now it’s at sixty five to ninety nine, and that’s considered normal.

We look for optimal that those ranges are just way too wide. And this paper down here was written in two thousand and eight by Nicholas and Friends and it looked at normal plasma blood sugars and they followed these patients for fifteen years. And what they found is that patients that had fasting blood sugars of greater than eighty four for every point over eighty four they had six percent increased incidence of diabetes.

So a patient who has a blood sugar of ninety four, fasting blood sugar, They have a sixty percent so ten points over eighty four times six, sixty percent increased incidence of diabetes within five ten years. That was the time frame that they looked at. So I do this with every patient all the time and it tell them it’s normal it’s just not optimal. And that’s kind of what we want to look at. Hemoglobin A1c, that’s pretty standard of blood sugar over three months.

And it’s a percentage of the hemoglobin that’s glycosylated with glucose in the bloodstream, less than five point seven percent is considered normal, five point seven to six point four is prediabetes and greater than six point five. Is diabetes. There’s a lots of false positives and negatives, but this is a pretty standard test and I’m sure everybody on here who deals with patients and knows all about it. We also look at insulins. We do fasting insulin.

Normal is two point six to twenty five almost. Our goal is really less than five we want the patients to use as little insulin as possible, and we can calculate an insulin resistance.

And we follow this along. So fasting blood sugar times fasting insulin, you’re going to divide it by four zero five, that’ll give us the proper units. We want it to be less than one point nine. And we’re going to follow this along.

So you’re going to find a patient that has a fasting blood sugar of ninety and a fasting insulin team is going to have a high insulin resistance. And again, this is another clue that even though they’re normal, they’re not quite optimal. And one of our goals is to sort of head off as long as we can any of these long term obligations. We also look at homocysteine.

Warmocysteine is form of looking at some nutritional markers.

It’s also a marker for artery damage, particularly coronary damage, also aerotid artery damage, heart attacks, and strokes. Our normal is less than eleven, our optimal or our goal is less than ten.

Our remedies are methylated B vitamins. Vitamin D, we can do a whole seminar just on that. It’s necessary for calcium and absorption, bone strength, the immune system, the heart, the brain, anybody that dealt with you know, the COVID patients over the last three years knows that the higher the vitamin d levels, the less severe the symptoms were, normal, in most labs is thirty to one hundred and ten. Optimal is fifty to eighty.

We do a whole laboratory thing. I’m not gonna go into where we got that, but if you’re you’re interested, let me know, and I’ll give you the calculations. This is a micronutrient test. There’s lots of companies that have it.

This is a serum test. And they’ll measure deficient sort of borderline and adequate nutrients There’s thirty two specific nutrients in this test.

These are vitamins from a to k, the antioxidants, neurotransmitters, and also give you a balanced score. There’s an organic, what is it called, OAT, organic acid test, that’s what it is. There’s another one. It’s a little bit more sophisticated.

It takes a little bit more time to interpret.

These are some of the quick start things that we use to get the patients going on their journey bisite has at least one program for each of these and you can just type in an elimination diet or autoimmune protocol, protein sparing modified fast and intermittent fasting are pretty much the same thing. And then we’re going to talk about some of our game changers. I’m just going to mention inflammation briefly. Again, having been raised in a previous medical paradigm.

The concept of chronic inflammation is a little bit beyond me So I lived for thirty years in Wilkesbury, Pennsylvania, coal country. This was a town about sixty, seventy miles southwest of it. And basically what you’re seeing here is that due to a series of political mishaps, the town was set on fire underground.

It was an underground fire that it was set on fire in nineteen sixty two. It’s still burning. And this is what you see as I see smoke coming out of the out of the ground. And actually by two thousand and two, the town was condemned Here’s a picture of the town in nineteen sixty two. This was Main Street, and this is a Main Street in two thousand and two. And you can see it’s completely wiped out.

And so this is kind of an analogy.

This underground mine fire is supposed to keep burning until those of you that are Star Trek fans will know that Captain Kirk was born in two thousand two hundred and fifty, and it’s estimated that that’s when this fire will burn itself out.

It’s called Centralia, Pennsylvania that is burning even as we speak. If you’re at all interested in it, it’s kind of an interesting history.

So what are we going to do to look for inflammation? So we like C reactive protein. There is sed rate, but I think this one’s a little bit more sensitive. Zero to three is normal. Our goal is less than one.

It looks at inflammation primarily in a cardiovascular system. It gives us a good handle on chronic diseases. Now if somebody has a cough of cold and infection, these numbers are going to be quite high I had a patient come in with an ulcerative colitis, and it was seventy one.

But that’s not really what we’re looking for. We’re looking for subtle changes So a patient who started out say six months ago and he was zero point eight and today he’s at one point four, they’re both considered normal. Your lab studies will not flag it. And that’s a concern to us. These are not specific. These are telling you something’s going on to go look for it.

Our remedies actually for this though when they’re high, when they’re over one point zero, we’ll look at omega three fatty acids and turmeric.

Anti inflammatory substances, and omega three fatty acids are good as anti inflammatory and antiplatelet.

It supports mental health as it has some antidepressant properties and some cardiovascular health. Trumeric or Kirk human is a good as a liver detox, make sure you use it with a black pepper or bioprene it’s called to help it be absorbed. LPPLA is a marker for vascular inflammation for it’s a predictor of coronary artery events, it has to do with plaque vulnerability. The next one, NPO myeloperoxidase has to do with plaque rupture. So a high LP PLA and a normal NPO says that’s warning Will Robinson, a high MPO, which is going to be the next one tells us that we have a more serious issue Niacin, omega three fatty acids, statins and fibrates are our goal here are the normal lab values up here. NPO, as I mentioned before, This oxidizes LDL bad cholesterol. This high numbers here indicate plaque rupture and this is a more serious issue.

POM is pomegranate seeds believe it or not. Kirk human, aged garlic and quercetin.

This is our hierarchy then for the road to inflammation.

A high carbohydrate diet leads to increased insulin and a chronic inflammatory response, we get these cytokines, these inflammatory proteins become elevated. We start losing glutathione and our our ability to handle the inflammatory compounds We get fat accumulation, skeletal muscle inflammation, and it’s the road to chronic diseases. The labs, which is just mentioned, c reactive protein, LPPPLA and MPO.

Chronic inflammation leads the weight gain. You knew I’d get around to it eventually, Katrina. So chronic inflammation leads to a decrease to T4 to T3, which leads to a state of thyroid resistance, thyroid holds in weight. Thyroid is your gas pedal.

It tells your body how fast to go. It affects every cell of the body, low thyroid function leads to weight gain, it increases insulin resistance, it increases leptin levels, it increases appetite, and increases the inflammatory cytokines There’s inflammatory proteins interleukins one six and t n f alpha. It also can lead to lower testosterone levels which increase an increase in aromatase leading to high estrogen levels high estrogen levels lead to fat, particularly in the belly. Pormones need to be balanced and we do this with every patient.

That’s kind of our specialty. I’m not going to go through this because this is a whole different story, but what I’ve given you here It’s basically just a hormone summary with the properties of what to look for for each hormone.

The functions and deficiencies here. So again, that’s a whole another course, and I actually have a put in the shameless plug. I actually have CME accredited video course on hormone optimization from the beginning. So That’s our shameless plug. Here is our evaluation, serum, you can do saliva and urine, a lot of my colleagues will only do saliva in urine, the state of Nevada, doesn’t like that, so they sort of force us to do serum.

And so I got quite comfortable with it. If we’re stuck with anything, we’ll certainly do to saliva the urine test. And pretty much everything that we talked about here And so now let’s get to it, the interventions. So I’m going to just briefly mention some of the older things that we used phentermine, topiramate, buperone, naltrexone which the trade name is Contrave, HCG, which we can’t really get anymore, can only get it in the commercial product. We did use that quite a lot paired with a five to eight hundred calorie diet and I know body site still has your program for that on there. Now Trexone let’s low dose naltrexone actually and what would sometimes do implants on that, and then we’ll talk about our incretions.

Down at the bottom here, these are some of the add on things that we’ll use to increase metabolism, burn fat.

And a couple of other things, especially if the patients can’t tolerate the incretins.

We like Tesofinsen and Motsie, which is tight. And I’m going to talk about this combination here. This is really hot off the press, and we’re starting to use this now for our maintenance program and I’ll give you the reference on that. This just came out in April of twenty twenty three with using this combination of metformin five hundred milligrams once a day and it’s my verdict is the trade name.

They used one hundred milligrams, and they found over six months about a seventeen percent weight loss just using a paleo diet and this combination So we’re starting to use this as our as our maintenance program.

We’ll talk about my verdict, there is an issue with it that a little bit vexing. So just real quickly, phentermine basically is speed. It’s an adrenergic uptake — we uptake inhibitor. It stimulates the nervous system.

Anybody who’s taken it, especially if you’re sensitive to it, have high blood pressure, you’ll start shaking like a leaf.

It increases energy an amphetamine like a medication, thirty seven and a half milligrams scored tablet. You can break it in half. It can be made as low as fifteen milligrams you take in hour before breakfast and side effects, there’s a lot of them tachycardia elevated blood pressure, dry mouth, there’s a lot of drug interactions here need to be a little bit careful with it, but we have used it fairly extensively. A lot of patients do, especially the younger patients do fairly quite well with this.

And they’ll lose five percent to ten percent of their body weight over about a six month period one here. If they stick to again stick to an exercise program, and a reasonable diet. Topiramate, topamax was always paired with it We used to use fentermine in the morning and topamade at night. It’s an anti seizure medicine.

This is an off label use. Well, actually it’s not off label now because there’s actually a combination That’s cool. I can use trade names, right? Is that okay?

Trad names are okay. Okay. So this combination down here is called Qsema Q s y m I a, I think it is. And it’s topiramate and phentermine in one pill. It’s a lot more expensive than if you just get them take them separately and off label use for topiramate is migraine headaches prevention bipolar disorder seizures and it actually acts on the frontal cortex to reduce appetite.

The doses that I’ve seen are anywhere from twenty five to eight hundred milligrams, usually fifty to one hundred milligrams is adequate.

As an adjunct to the fed chairman.

You use this one at bedtime and some side effects or memory loss dizziness fatigue brain fog, quite frankly, again, I don’t use this much anymore because of all the new things. But when we did use this, it was pretty benign. We rarely had any side effects. From this at all.

The fenteramine we did have some problems with increased heart rate. So naltrexone buperone is, so low dose naltrexone is a potent anti inflammatory and it increases endorphins in anything less than four point five milligrams that’s in the separately that has to be compounded. This is a combination. This is an FDA approved drug.

It’s called Contrave. Quite frankly, I’ve never really had a lot of success with it. Theoretically, it should help. It targets the CNS pathways influencing food intake.

Now Trexone suppresses neuron inhibition in the hypothalamus.

It should increase energy and decrease appetite site.

You have to use a lot of pills.

Like I said, it’s FDA approved in my experience, we’ve not had a lot of success with it. Low dose Naltrexone is a compounded water down version of Naltrexone. And again, this is a whole another topic that we can spend time on.

But in the realm of weight control, it reduces insulin resistance, it increases growth hormone, which will increase metabolism, It burns fat. It reduces lean body weight. It decreases cravings.

It modulates the opioid pleasure receptors. It acts as an anti inflammatory, and it improves sleep, and it increases that conversion of T4 to T3. Remember, inflammation slows that down.

Very few side effects.

I found in the literature, it says nausea thirty two percent in our experience. We use this a lot a lot of things. We use this for all sorts of autoimmune issues.

We rarely have anybody have to stop it because of nausea.

We do like to dose it at bedtime. It works by blocking the opioid receptors for six hours, then it wears off in six hours that it’s working, it creates endorphins and it stimulates anti inflammatory cytokines When the medication wears off, the opioid receptors are then flooded with the anti inflammatory cytokines and the opioid receptors So we like to dose it at bedtime so that your patients are ready to go in the morning but about ten percent of the patients experiencing insomnia. It’ll happen the first night or two that will happen and you’ll know right away. There’s a whole schedule of lowering taking it two hours earlier until insomnia goes away, it got to be a little bit too much for me.

So if the patients have insomnia, I just tell them to take it during the daytime. We’ve not had anybody have to stop it because of that. The other thing is the books call it vivid dreams, which are nightmares, and there’s actually twenty percent of the patients will report that. And they’ll tell us some kind of wild stories.

Again, a lot of them like it, and we don’t really have anybody have to stop it because of that. Now Trexone can come as an implant too like the pellet, and the pellets are one point one to two point two grams. You can use them the last they’re good for about four months. And again, they’ll eliminate not all cravings, but the lower cravings you still have to do your lifestyle changes.

And so that comes — so that took us now we’re now we’re up to it now. So I’m going to call them incretin hormones. I’m going to change it from semaglutide because there are two of them that are FDA approved, and there’s a third one that just two weeks ago, on May thirty, it was started on their Phase three studies, and a big study came out just on Monday, and I have it here.

So increasing hormones are gut peptides that are secreted after nutrient intake, they stimulate the increase in insulin secretion by two to threefold.

There are two types glucagon like peptide one and glucose dependent insulotropic polypeptide So there’s two different types. They worked a little bit differently.

The first in Cretin came out in two thousand and five It was called Bietta. It was a daily injection.

A newer version came out a couple of years later called Baidura, which became weekly injection.

So, the glucagon like peptide one stimulates insulin secretion and it inhibits glucagon. It controls appetite and cravings It slows emptying time from the stomach, it increases resting energy expenditure, and it improves sleep.

And that this is your GLP one. This is your semaglutide.

I’ve also heard it pronounced semaglutide in some places too, so I’m going to use semi blue tide because I’m from the East Coast so glucose independent insotropic polypeptide is the second of the incretins. This one activates glucagon receptors. It induces insulin secretion it prevents apoptosis which means death of pancreas cells, this is where insulin is secreted from generated It stimulates glucagon secretion and fat accumulation.

It influences hippocampus, regulated memory and appetite and satiety, and it actually works in somewhat in bone remodeling and has been used as an adjunct for osteoporosis and fractures.

So the GLP1, that’s your semaglutide, the GIP, it’s GLP1 GIP that’s your tip here is I think it’s I can never pronounce it right. Mourzano Monturo, something like that.

And so those are your two ingredients.

These were all of them, these are all the ingredients. So these are the early ones and you see here Genuvia, which is an oral agent, is actually considered an ingredient also. So the first one came out in two thousand and five.

By Doran, which became the weekly one was twenty twelve, VICToza in twenty ten.

Trulicity, this one here, I’ve not really heard much about, trulicity has been out since twenty fourteen. And we used to get calls for this for weight loss also, but it was kind of cost prohibitive.

So in twenty seventeen, Novanortis came out with semaglutide and once a week injectable with improved glycemic control and this was a big jump. This was really one of the first, the better you know, the weight loss is a side effect, basically. I mean, it tells your brain that you’re not hungry. But and there were it was three times the it was threefold increase in weight loss with semaglutide osempic than with all of the other incretins and even, you know, our other interventions.

Ribelsus is the oral form. I don’t have a whole lot of experience with that. Maybe somebody does here. Then in twenty twenty one, Nova Nortis took semaglutide reformulated it a little bit, changed the doses and got an FDA approval for weight control.

In twenty twenty two, tirzepatide came out, Montero, which is your GLP-one and GIP agonists.

And then, and I have a hard time pronouncing this one. This is brand new. This information came out and I’ll show it to you a little bit later, June twenty six, twenty twenty three, today is June twenty eight, twenty twenty three. But this has been studied for a little while and this is called red actuateide.

It’s not FDA approved yet. They just finished phase two studies. They started phase three. And this is a GLP one, GIP, and glucagon agonist.

And according to the gurus in this field, this is supposed to be the holy grail of of the weight loss in Cretions. And what you’re gonna find is that the weight loss is much better here with much less side effects than with even semaglutide and tirpyridide.

So we’ll talk about semaglutide first because this became our first game changer This was a study done in two thousand came out in twenty twenty one. It was a sixty eight week study.

Patients had fourteen point nine percent was fifteen percent average weight loss a third of the patients lost twenty percent of their weight, and seventy percent of them lost at least ten percent of their weight. And that’s pretty much been our experience.

That holds pretty well. Unfortunately, men lose weight more easily than women.

But even we’ve had women lose up to thirty pounds in a week in a month with an average weight loss of about a half a pound a day for women and about a pound a day for men if they follow a diet.

It controls appetite and cravings slow stomach, empty in time.

It stimulates insulin secretion, this one inhibits glucagon, it improves sleep, increases resting energy expenditure. That’s how it works.

It’s eighty nine percent bioavailable. It peaks in one to three days, you get steady states over a week and you get in a week, it’ll sort of stabilize and you’ll get a steady state in over four to five weeks. The half life is about seven days.

So it’s a long acting medication.

This was a forty week study done in twenty twenty one with Wagovy, which was the two point four milligram per week, and the highest dose here in this forty week study was sixteen point two percent weight loss. This is placebo here. This red one here, this is trulicity, this one of the older ones, and these are other doses of the semaglutide.

The higher the dose, the more the weight loss.

This shows, again, this was that sixty eight weeks, this was a placebo, and this is the sixteen percent weight loss or average weight loss with semi glue type.

But there’s danger, Will Robbins, Again, those of you of a certain age will remember lost in space and the robot here, there’s a high incidence of side effects.

And according, and this is the official rate, nausea of forty four percent nausea to the point where the patients can’t take the medication, and there’s a high incidence of discontinuation of the medication because of this.

Diureate, vomiting, constipation, abdominal pain, headaches and fatigue.

Now there’s some ways around it. The most important thing you need to emphasize for the patients, if they want to just continue their eating ways, they’re going to get sick. If they’re going to eat junk, if they’re going to McDonald’s three times a week, if they’re eating, you know, if they’re not eating whole foods, plant based foods, if they’re just going their high carbohydrate diet, they’re gonna get sick. The patients who don’t get sick are the ones who change their eating habits and they do much better. And almost to the point where we have less than four percent discontinuation rate when we follow that plan.

So this is what we do. So again, most important, no junk food. You also have to limit your the size of your portions also. Five hundred calories in a meal is probably the max that you wanna do. We don’t really have people count, you know, count calories.

But, you know, I mean, you can’t go to the buffet at the casino and just load up and want it. I mean, you’re going to get sick. The body psych program is really great, you know, and it saves us a lot of time and effort.

We just put the patient’s names in there. We send it off, we check-in with them, make sure they’re doing it. They’ll check-in with us also We always have our patients get some fresh ginger. Ginger seems to be seems to really calm the nausea from the semaglutide, and so we tell our patients to always have some fresh ginger around. As far as interventions, prescriptions, proemethazine, zofran, pepto bismol, those of us in sort of alternative world zinc carnosine is a good choice l glutamine is another good choice. Again, I’m allowed to use the brand names. So we like orthomolecular makes a powder called glutice shield, and it has the zinc carnosine in it, it has dechlorinated licorice, which we use for gastroesophageal reflux disease.

It also has l glutamine in it and has some digestive enzymes. We really like that one. It’s not expensive. And it actually tastes good also.

So vitamin B6, we’ll talk about that. And BPC-one hundred and fifty seven, if you’re not familiar with that, that’s It’s a peptide.

It’s a kind of a growth hormone derivative.

It comes from gastric juices and they’re potent anti nausea agents, and we’ve used these very successfully to decrease our nausea and actually diarrhea incidence, discontinuation rate, our discontinuation rate is less than four percent and the official from the company is forty four percent. So I think we’re doing a fair job, and these are the two main agents we’ll use. I’ll talk about them in a minute. Diarrhea, you want to increase the fiber, you want to make sure they’re hydrated and a loperamide emodium. If they need that, vomiting against the same as the same as nausea, the promethazine zofran, you want to avoid really high fat diet foods especially right around or the day or two after the injection.

And again, there’s their l glutamine, diglyceride, licorice, as in carnosine and aloe vera, and our B6 and BPC one hundred and fifty seven. Constipation, this is fairly common because, you know, you were gonna decrease gastric emptying, that’s what the drug does. You’re going to give some high fiber foods, figs dates of green leafy vegetables, Mirillax metamucil, the old standard’s cod liver oil, has a lot of good uses and affects magnesium, particularly magnesium citrate aloe pectin.

These are all sort of remedies. Abdominal pain, so one of the sort of be on the lookout for is pancreatitis.

I’ve not seen it. We’ve been using this for drug for over well over two years in this form now. And we’ve not seen it, but it’s always in the back of her mind. So you always need to make sure somebody start calling about abdominal pain, we’ve made sure that they’re not suffering from a pancreatitis.

We use castor oil pack Epson salt baths. Again, licorice root, black human is a good choice and again ginger and mastic and usually these comes in combinations.

That gluteus shield works nicely.

There’s apex energetics makes one called glucose flam, glucose, g o u c o p h l a n, I think, glucose flam.

Headaches fourteen percent make sure you check your blood sugars. One of the nice things about the semaglutide and all the ingredients that we use is that if the patient’s blood sugars are normal we rarely if ever see an episode of hypoglycemia, I think I have some statistics coming up just and you’ll see it’s almost nonexistent.

That was one of the things we worried about.

Gluten free diet, I’m firmly convinced that everybody should be on a gluten free diet, regardless of your status and gluten’s just not good for anybody, increased fluids, magnesium, If you like essential oils, peppermint oil, lavender oil, arnica rub the oils on the back of your neck or your temples, Arnica, fever, few butterbur, vitamins B1 and B6.

If it seems to be related to menstrual cycle, We use some progesterone cream on the temples.

I thought you can get a two percent or a five percent over the counter. You don’t need a prescription for it. And one of my other hats, as you can tell I get bored easily so I go and learn lots of stuff. So I’m actually an acupuncturist also. So battlefield acupuncture is taking little tiny gold needles and putting them in these spots in the ear. And usually within ten minutes, the headaches are gone. I mean it’s pretty dramatic.

Fatigue we want to watch out for food sensitivities the leaky gut syndrome, again B1, B6 replacement. D ribose is a B type vitamin, which is good for energy.

Checkor magnesium, checkor potassium, and of course stress reduction techniques.

Some other tips for success the weekly dose, I have it here on Friday.

You want to make sure, especially early on, that they’re free the next day or two. You don’t want them to have a big presentation on Thursday and hadn’t the user shot on Wednesday and especially right at the beginning and have them become ill.

So you want to have, so we usually encourage them Thursday or Friday, especially if they’re off on the weekends to have light meals for the next two days.

And to test things out. And again, no junk food. We have ginger on hand for them. We tell them to have a little pepto bismol on hand.

And a little bit of a — it seems a paradox, but a little bit of a fat snack. So some coconut oil or some avocados usually will help ease the nausea also. Make sure they drink a lot of water, six to eight ounces a day. Remember what the drug does is decreases their appetite.

And we have seen on occasion rarely, but on occasion someone not drink enough and they end up with a bit of dehydration. Usually haven’t put a half a teaspoon of sea salt or pink Himalayan salt in one of the glasses of water, They need to do some physical activity, you know, do what you like to do, move throughout the day, you know, some of us sit in front of a computer and flap our gels all day like I’m doing and I don’t know if that’s what Katrina does too. So you need to move around a little bit.

Try some new recipes. Body site’s great for that. They have all sorts of recipes in there and there’s all sorts of diet plans And before the body, the semaglutide diet plan, we would pick out one for the patient or we’d offer it to them and our most favorite were either the paleo or the keto, or the Mediterranean gluten free, that one seems to be pretty popular too. Some warnings, family history of medullary thyroid cancer is considered a contraindication.

So if you ever see how some of these studies are done, they feed rats four hundred times or five hundred times what a dose would be for their body weight. And then the rats ended up with medullary thyroid cancer. So anybody with a history of it that’s considered a no no.

Routine monitoring of calcitonin or using thyroid ultrasound is kind of uncertain.

And so just be aware of this Again, I’ve not seen it at all. I haven’t seen anybody have a thyroid issue with the semaglutide or it appears eyed. Weight loss in general. We’ve seen this over the years. Hypoglycemia, again this is a hypoglycemia drug, although we’ve not seen this. Colylithiasis with rapid weight loss is an entity.

So be aware of that. You can get a little bit of an increased heart rate And you know, the patients that were previously depressed get a little bit less depressed and it’s been documented a suicidal behavior in ideation. Again, I’ve not seen any of this. I mean, most of our patients are over the moon This is probably the one of the best things we’ve done in forty years.

Food choices, and I told Katrina, I stole this right out of body site program. So the Yafus, your fruits, non starchy vegetables, whole grains, I put in with caution, grains are gluten’s not so terrific for anybody, nuts and legumes, high protein foods, and your good fats, coconuts and avocados, and stay away from the junk. Fried food, white flour, white sugar, dairy is actually if you’re sensitive. You can get an allergy like syndrome.

Refined grains, and sugary drinks, alcohol is not so good for you either.

So right now our main recommendation the body site plan plus the gluten free diet.

Here’s a dosing schedule. For the semaglutide, we’re gonna start at zero point two five milligrams once a week for a month, for every four weeks, every four weeks, we increase the dose and you’d go up to two point four milligrams, that’s WAGOVY if you’re using those zempic, it only goes up to one milligram. Quite frankly, we see pretty good results with up to one milligram and we rarely go any higher. I just don’t really seem to need it. Somebody else has a different experience, you know, can let us know. But the lower doses as long as you moderate what you’re eating and get some exercise seem to do quite well. So One of the problems is cost.

So at the moment, there are some off label ways to get around that, but I think it’s going away. And I don’t even want to get into it anymore.

At this point, the drug companies and FDA seem to be cracking down on the compounding pharmacists that have been making it. So for right now what we’re doing is we’re gonna be doing a once a week shot as prescribed, and we’re gonna add in our we’re gonna add in our little extras here. So this little chart here is kind of a summary for semaglutide. It’ll tell you what it does and what it is glucagon like peptide one analog, approved for FDA for diabetes and the higher dose will go these approved for weight loss and what it does, controls appetite, craving, slows empty, time increases resting energy expenditure.

BPC-one hundred and fifty seven, like I said, is an anti inflammatory agent, it actually comes from gastric juices. It was actually identified in nineteen oh four by Pavlov, of Pavalonian dogfane. He didn’t really know what he had, but they were using it in czarist Russia for upper GI issues.

And it was identified fully in nineteen ninety three.

It is an anti inflammatory agent and it promotes vascular formation it comes as an injectable, it comes as in an oral form. In an injectable form, it’s extremely effective disruptions, joint pain, arthritis, those kinds of things.

Any type of GI issue, leaky gut, irritable bowel syndrome ulcers, ulcerative colitis, it has a good effect on it. It is a potent inflammatory agent and vitamin B6 is used twenty five milligrams up to three times a day. It’s used in OB now for morning sickness.

And so we put it all together. We got our weekly semiglutide shot, the BPC150b6.

We’ll use that as our anti nausea agent we do ten weeks on, two to four weeks off.

The literature tells us to use it continuously It’s been our experience that if the patients don’t take a break, they get accommodated to it and it stops working, especially for weight loss.

We added in another, so berberine is considered the herbal semiglutide and we added this brand in, which is again I can talk about brands. It’s from NewMedica. So it’s Burbervine vaso QX three times a day, it improves energy demand.

It’s a central regulator of energy homeostasis, and it contains gynostemma, which is an AMPK or energy regulator. Basically, it’s a fat burner.

A lot of us have used berberine and said it didn’t really lose weight, but you have to use it in a fairly high dose. You need fifteen hundred milligrams a day. So the diet, so we recommend or is body site the body site program will sometimes do Mediterranean keto paleo or the autoimmune diet.

If you have a sweet tooth, two tablespoons of apple cider vinegar and six ounces of water and you can do that two or three times a day. Usually kills the sweet tooth, that works quite well. For exercise, high interval intermittent training, that h I I t, I’m not saying that right, and then we decided to have a little bit of fun. So we went back into the archives.

YouTube is great for this now. Those of us of a certain age probably spent one hundred dollars for for a tape, for eight minute abs, eight minute legs, sweating to the oldies, buns of steel. You can do all of these exercises in eight minutes, There’s no equipment. You don’t need a gym.

You don’t need a pair of shorts and a t shirt. You don’t have to go anywhere. It doesn’t cost anything. And the exercises are perfectly fine.

They’re wearing everything looks campy. They got the 1980s hairstyle and and spandex and whatnot. Those are kind of fun. There’s a lots of them.

And that’s kind of what we recommend.

And works out quite well. I’ve been doing eight minute abs now myself for more than two years.

For maintenance, we talked a little bit about metformin and Mibertic The problem with my Beroran, my verdict is that it’s at the moment trade name only and it’s quite expensive.

So we can for metformin, if you don’t want to use medications, we can use the berberine, you need fifteen hundred milligrams a day, chromium to colonate about twelve hundred milligrams a day. For the mybiotic, we use resveratrol, fifteen hundred milligrams a day and human and you can use either one of these. You don’t need both. These are a couple of other things that we can add in.

So So now let’s talk about tipiraside. How am I doing on time here?

Are we okay?

Okay. So to pyrazide, this is a morgiano, right? Orgiano?

So this is from Lilly and this is the GLP-one agonists and GIP. So this is semiglutide with the other in cretan hormone.

You get an increased satiety, increased weight loss, decreased appetite, the dosing numbers are different.

Basically, we see a better weight loss with less side effects with tirpyrazide than semaglutide.

This actually is here’s your weight. This is the weight difference from tirpirozide to semiliglutide. We get the lowest dose. This is the lowest doses. Of each, you get about one point nine, this is the difference in weight loss, one point nine kilograms better with terpyrazide, the highest dose five and a half kilograms which is about twelve pounds for the topirazide versus the semiglutide.

The side effect profile, as you can see here, is almost the same but a little bit better for a pyrazide than semiglutide and hemoglobin a1c blood sugar response is much better with the pyrazide versus the semiglutide mean it’s not bad for some of the glutide, but it’s a lot better for the tipira side. The weight loss here is much better with the tipira side. Also, it’s a little bit more expensive though.

Hemoglobin, again, hemoglobin A1C is better.

Cholesterol difference is better also. This is the HDL, this one you want to go up. Semiglutide is in gray.

The different doses of the topirazide are in light, medium and dark blue.

Incidence of nausea is less with the tirpuraiside also.

And incidence of hypoglycemia here is really quite small. I mean, there was one patient in the five milligram and one patient in the fifteen milligram category and none in the semi gluteide. So pretty much none, and we’ve really not seen it.

Either. Injection site reaction, we don’t really see a whole lot of that either. These kind of side effects are really pretty minimal.

So now there’s Retatritide, again, I have a hard time pronouncing this. And Retatritide is has three receptors. So it’s your GLP1, GIP, and it has glucagon in it, which further suppresses appetite and increases energy expenditure.

This was just finished. This study was done in September of twenty twenty two. It was a Phase two trial. There was a twenty four percent weight loss in forty weeks versus twenty percent for tirpirozide.

And this was published Monday. June twenty six. So I want you to know that we’re right on top of everything here. Twenty four percent weight loss at the highest dose within forty eight weeks and these are the other doses for tetrachide I don’t have a trade name for it yet. They just started May 30th with just starting the Phase three trials. It’s not supposed to end until September of twenty twenty five, but I have a feeling we’re gonna see this a lot sooner.

The other bonus with this is you have relatively liver liver fat reduction of eighty six percent So this actually improves fatty infiltration of the liver, and ninety percent of them had resolution of their hepatic steatosis.

So this is again this is something new and it’s pretty spectacular.

So this Phase two trial just as a summary, forty eight weeks, twenty four percent weight loss at the highest dose an average absolute of fifty eight pounds the weight loss thresholds For all doses was a hundred percent. At twelve milligrams, nearly half of the patients lost more than twenty five percent. A quarter lost more than thirty percent. And you had very good lipid profiles hemoglobin A1C’s also.

This is another one I can’t pronounce This is an oral agent of the same — also by Lilly. A Retatritide is also from Lilly. This will be an oral agent. This is also in Phase two studies and after thirty six weeks, a little bit less weight reduction, but this is a pill.

This is not a shot.

And this one’s fairly new also.

So this is just a comparison head to head from the lowest dose to the highest dose, so sosamics. Semiglutide The lowest dose, they have an eight percent weight loss versus the ratatritide and sixteen percent to pyrazide. These are about the same, highest doses about the same weight loss, a big jump again in ratatitis. So when that one comes out, that’ll be the game winner. What to do when the party’s over, Again, we talked about metformin and mirabegron.

I can’t say these in my verdict, which is approved for overactive bladder. And again the issue with my verdict is that there’s no generic and it’s really expensive.

Mibergic, there was an eleven percent decrease in body weight over forty weeks by itself there was a four percent weight loss with metformin at five hundred milligrams twice a day by itself. In the combination, there was a greater than a seventeen percent decrease in body weight. So what we started to do, we use a lot of berbering So we’ve been using berberine and resveratrol as a substitute and we have some studies on resveratrol that’s fairly comparable to these medications.

Again, at a high dose, fifteen hundred milligrams a day, and we’ll report back in six months or so and let you know how that goes for us. Okay? The problem with this one here and a bit better on the my verdict, this is with a good Rx four hundred dollars a month. So that’s kind of not practical.

I tried getting it wholesale and it was like seven hundred dollars for five doses. So it’s really too expensive. So what they do, both of those drugs, they convert white fat to brown fat they increase thermogenesis of fat burning.

The metformin doesn’t work all that well alone. There was a four percent decrease in body weight. But when you add it in with the Mcverteuron, we end up with one plus one equaling four.

The subjects also showed an improvement in glucose utilization, a couple of other things and then we’ll wrap it up So ANPK is an energy pathway.

There’s lots of ways to address it especially when ampK is deficient this happens a lot with aging We get abdominal obesity, loss of insulin sensitivity, increased cellular stress, mitochondrial dysfunction, chronic inflammation, So when we stimulate this pathway, it increases fatty acid oxidation and ketosis, it inhibits cholesterol and triglycerides, inhibits adipocyte lipo lipolysis.

So these are ampK activators, methylene blue which is actually commercially as a dye does come in a food grade substance in use in autoimmune issues So there’s metformin, there’s ginger, we talked about ginger, butyrate is short chain fatty acids, fermented in the liver decreases insulin it reduces insulin resistance, and there’s gynostemma, which is a Chinese herb that transport fats into the cells and it decreases fat storage and improves insulin instance by thirty five percent that berberine VASO X from Newmedica contains berberine and gynostemma. So that’s one of the reasons we like that. This is some more information on gynostemma.

Butyrate as again short chain fatty acids.

It helps with weight reduction. There’s references for that. Oxytocin, the love hormone has some weight loss component also.

So here’s again a summary. This is our semaglutide tirprazide injection plan. We use semaglutide and tirprazide interchangeably.

And there’s appears a couple of ridiculous things now. So you’re going to we’re hearing this nonsense.

Some people are just never happy with anything.

Anybody’s heard of ozempic face. So it’s a big surprise that if you lose weight you’re going to lose some fat in your face. So this was, if you look up Ozempic face, I mean I blocked that arise, this is actually a picture that I got off of the Ozempic face article, and I think she looks pretty good.

And then there’s Osympic finger, you may have heard of this one. You’re gonna lose some fat in your finger and the rings and bracelets are falling off.

This is first world issues. So I came up with a couple of my own, also Ozempic butt is another one. So here’s my own Ozempic Calvins because you know you’re gonna lose weight or and then you’re going to have to go buy new genes.

Here’s Ozempic dress or Ozempic Chico’s because you know, you’re gonna have to go get some new dresses.

We also have like I said a mind body program.

There was also a skipped over this was Ozempic hat, an ozempic foot. So these are more things that we can complain about. If you go on YouTube and put in some of these things, you’ll find these people saying what are you doing this for? You’re gonna end up with ozempic foot or ozempic face. So if you end up with ozempic face and end up with increased wrinkles, we can fix that too. We do a lot of aesthetics here.

I’m going to stop there.

If you want any questions, comments, complaints, Yeah. So we have a couple questions in the chat box. I’ll go through those for you and then you can speak to them and anyone else if you have any questions as we go through those.

Feel free to send them in the chat. So the first question that came in kind of earlier in your presentation was Is the HSCRP more specific for cardiac disease? And should that be used instead of a regular CRP? Yeah, that’s the one we use.

So I, you know, we use it so often that I just I forget that there’s two of them. We do to use the HS one. Okay. Okay.

The next question is do you use LPA and APOB as a screen for further CV inflammatory markers.

Yeah. The answer to that one is yes also.

Another question is, will you address a lean body mass loss using semaglutide and tirzepatide?

Again, adequate exercise, adequate lifestyle changes, you’re going to get a little bit of lean body mass loss, but on the whole, the patients do quite well. And we were not really seeing a real issue with that. Again, I could be wrong. Somebody could be up, you know, could have have a different take on it, But our patients lose a substantial amount of weight, they feel better, and this has been a real game changer for us.

We do use intermittent fasting as one of our plans and Katrina has the mind body program and she’s more than welcome to send it to anybody who wants it.

This next question is about your slide says tirzepatide is given I m. It is given s q. Correct? It’s up q. Yeah. Did I put did I put I m? That was a mistake.

Yeah, so cute.

This question, did they just come out with a new oral version? I think that’s in regards to this latest one, the R1. Correct?

That one, the one that I showed you beginning with the o that I can’t pronounce, that’s not out yet. There’s one called Ribelsus which is actually semaglutide in a pill form.

And we’ve had two or three patients use it and they do lose some weight with I don’t think it’s as good as the injectables and quite frankly I think using the injectable, there’s a psychological component to it also.

Taking a shot versus taking a pill. I think we’ve always done some injectables in one form or another sometimes we use peptides. We always do better with the injectables than than oral form in in the interventions that we do.

So on this next question, you can speak into it if you do this personally and then I can sync I can speak into what syncs with body site. Do you follow body composition? And is there a preferred device to measure that?

I don’t because I don’t have I don’t have and we have a scale that gives us body fat, but there are very sophisticated body composition machines.

Most of our patients, they’ll go to a gym, they’ll go to a trainer, they’ll have that. So personally, I don’t Would I like to do that? Yeah, but someday maybe when I have a couple extra dollars.

Yeah, I can speak into the devices that sync with body sites. So we have the Inotec home scale, which obviously is not as accurate as those that you can, you know, hold with the hands, all four appendages.

It’s the Inotech scale directly with the app so the data comes through automatically.

And then we are also integrated with the Inbody scale. So if you do have a brick and mortar where you have that in off this that syncs with the platform as well.

A question that just came in, I’ll Just give my little tidbit is is it better to use the body site intermittent plan or the semaglutide plan? The semaglutide plan That is breakfast lunch and dinner. The recipes are lower in fat with lean proteins, including plant based protein, that incorporate whole grains, fruits, and vegetables, whole grains with caution, of course.

I don’t know if there’s preference, Dr. Clearfield, I don’t know if you want to talk into if intermittent fasting is better. Perhaps it’s not what’s best for everyone.

Right. We do it individually. The semi your semi gluteide plan is fairly new to us, so the jury’s still out. But, you know, it’s a paleo light, and that’s what we’ve recommended.

And we usually we ask the patients, you know, what if they have a preference, If they don’t, we usually do go with either a paleo, keto.

And like I said, I like gluten free for everybody. I don’t think anybody should be eating gluten ever.

Whether you’re on a diet or whether you have any kind of medical issues or if you’re just fourteen years old, You know, it’s just not good for anybody as far as I can tell.

Patients just feel better when they’re when they’re when they’re off of gluten. It’s not easy to do. It’s getting easier, but it’s not it’s not an easy thing to do.

Can you comment on compounded time. No. Well, I just did, you know, that it seems to be becoming a problem. I guess they were too it was too successful and we can’t have nice things. So and it was a lot less expensive and it was very successful.

So of course, you know, we have to you know, we have to we have to put the kibosh to that. So what can I say? So like I said, I gave you the or or or or version of the the the commercial product. So Mhmm. Yeah. And again, the intermittent fasting is beneficial to everyone I agreed.

I I do need to check, but I am actually pretty sure that our semaglutide planet has whole grains, but I think that it actually might be fully gluten free. I need to do a double check So don’t quote me on that, everyone here. But I’ll send I’ll include that in the recording as well once I get confirmation on that. You’re going to fix that if you’re going to fix that or put up another one. Right? Yeah, I’m pretty sure it is.

Yeah, don’t harm me too like that in place. It changed name of it to semaglutide to pyrazide or in cretan to include the new ones and the ones coming down the road. So Yeah, since you brought that up, you guys can be the first ones to know that we will be launching a tirzepatide program. And then based on doctor Clearfield, suggest and will also be launching just a general increase in weight loss plan, so it won’t be specific to any one medication. As you’ve seen here, as early as two days ago, this new research coming out out about this one, so we wanna make sure that we have some evergreen plans for you guys to use as the research develops and more endocrine medications come out.

Alright.

Have you used a metabolic breathe machine?

No.

In a minute? Anybody has information on it, let me know.

And can I put in another shameless plug?

Tuesday night, as you know, Katrina, because you’ve been on, we have an integrative medicine webinar every Tuesday night eight o’clock eastern five PM Pacific, and we’ve been doing it for two and a half years.

And if you have any information on What was it? Metabolic something breathing machine? We’d be here about it. So can I put my email address in the chat? Anybody wants to yeah, of course, of course, and I’ll keep going through these questions while you do that.

Aileen asked is your how does your intermittent fasting program look like? We have three intermittent fasting programs. One is the Clean twenty eight intermittent fasting, which Clean twenty eight eliminates sugar is gluten, dairy, alcohol.

Then we have the gluten free Mediterranean intermittent fasting plan, which stuck Clearfield mentioned earlier as pretty popular in his practice, the gluten free med, and then it’s just an intermittent fasting version.

And then we have the intermittent fasting paleo plan based on our paleo program intermittent fasting.

Another question, are prediabetics being covered by insurance companies for Osympic and Munjaro.

I have no idea.

We gave up dealing with insurance companies about two years ago and and haven’t looked back. So I really don’t know. I guess some of them might cover it, some of them don’t.

We get every day, we get pre authorizations for this or that, and we gave up we gave up on that too. You know, we we give the patients a letter when they start with a saying, we’re not gonna do it. Because it was taking hours. I mean we had one person just doing pre authorizations and like it or not, we’re running a business. I mean, I can’t pay a person forty hours a week to generate nothing, so insurance companies can turn us down. Don’t ask about testosterone replacement. It’s another story.

So the answer is I don’t know. And that’s okay. Well, I think that’s all of our questions that we have here today.

We will be sending out the recording later this or noon. We will also be including in that blog article that has the recording, the mind body connect handout that Dr. Clearfield mentioned earlier in his presentation.

If you have any questions, feel free to email doctor Clearfield, his email’s there in the chat. If you have any questions about body site or this new semaglutide plan that we launched, you can email me directly at katrina with a k at body site dot com. So thank you everyone, and I hope you have a great rest of your Wednesday.

Thank you, Katrina, for inviting me. Sarah love. Of course. Thank you again. Someone’s asking if there’s a link to your Wednesday class.

I gave I gave you that my email address is right here. Yeah. Email him and then you’ll get that over to them, I assume.

We’ll get you going then. K?

Alright. Thank you everyone.

Thank you doctor Clearfield for being here with us. Thank you.