Microdosing, split dosing and peptides | GLP1 Q AND A Live with Pat Taylor, MD

[00:00:00]ing. Welcome. Oh, we lost Dr. Taylor.

[00:00:02]Welcome [laughter] in. Um, if you're new here, my name is Britney. I run this YouTube channel, Britney Rose GLP1, where I help to advocate for GLP1 care for all of us. Um, and I am joined again today by Dr. Pat Taylor, who is the chief medical officer at Join Bell as well as Live Vital. And we're going to pick his brain a little bit. Um, I have a few things that I want to kind of pick his brain on and see his responses on.

[00:00:26]And then of course I will open up the the floor to you all to ask him some questions as well. Um I know we're doing this a little bit earlier than originally planned so some of you guys might be catching the re or the replay of it which you know is fine. Um we'll just if you have any questions on the replay just drop them down below and we'll cover them next time. So Dr. Taylor, welcome.

[00:00:47]>> Thank you so much. Yeah, thanks for uh adjusting the time. That was my my bad everyone. I was traveling and when I set this up and didn't realize there was a time change on my calendar. So, um, yeah, happy to be here. Excited to answer questions as always. Um, lots of people we recognize, I sure will come through, but hopefully we'll get lots of fun questions and be able to help everyone out.

[00:01:08]>> Yeah, [snorts] of course. Oh, I don't need to be watching this on my iPad.

[00:01:12]Okay, so the first thing that I wanted to dive into a little bit with you is this whole topic of alternative dosing, right? So, either micro doing, split dosing. I mean, I've even seen people taking it like once a month. you know, just very rarely. So, I kind of want to see I want you to let us know in a way that we all can understand what are the differences between say micro doing which Bill actually just launched to split dosing and what are the benefits who would benefit from each of them you know that sort of thing.

[00:01:40]>> Yeah, I that's a great question. Um I think it's really important to kind of set this up with a couple of like things to understand about how drugs work. um like things like therapeutic doses and things like half- livives and steady state. So, I'll briefly cover that real quick. So, um a therapeutic dose of a medication is the amount it takes to get a response, right? And so, a very common one we use in the medical field is things like diuretics, like Lasix.

[00:02:12]People hear about water pills. And for things like uh water pills, it actually takes a certain amount for each person to actually trigger the response at all versus some medications you have to like you you'll get a response. It's just very low and it's very dose dependent.

[00:02:28]And so for every medication, you have to know what is the therapeutic amount that will actually trigger a response. Um and then you have to think about both half- livives and steady state. So half- livives is the amount of time it takes for that medication to h be metabolized in half. Meaning if you inject, you know, 100 milligrams of something, the amount of time it takes to get to 50 milligs of serum concentration. Uh it's also important to think about how long it takes to get to that serum concentration. So for GLP1s, let's break that down. So for something like tzeptide which is probably the most commonly g used GLP1 it has a 6 day halflife and for most medications it takes 3 to four half lives to reach what's called serum steady state.

[00:03:20]>> So that means in order for you to actually be at the therapeutic amount that has been either studied or with the expected response you have to have it in your body for three to four half- livives. meaning you do, you know, a week of turseptide, 3 to four weeks later. That's you're actually only at steady state 3 to four weeks later. So for a lot of people when they say, well, I didn't feel anything the first time or I didn't feel anything the second time or I didn't feel anything the third time and then I started feeling it the fourth time and then I went up a dose. The reason that is is because um colder allergies. Uh, I was in Nashville having a lot of fun for my bridal uh party uh stuff going on. My wife and I are uh having our wedding uh in a month. So, thanks Christie. Um, so that's why my voice hurts cuz I was singing to to country music because I'm from Nashville uh near there. So, um, thank you. So for that steady state concentration, that's I think that's what's so important for people to recognize is there's a reason why when you make a dose adjustment or when you're starting a medication, there is a lag time. Um, and the reason that is is because for the standard dosing of these GLP-1s, they are measured at those halflife and and so if you're look starting at 2.5 and you do a month of 2.5, you're actually just getting to the the therapeutic effect of the 2.5 milligrams and then most people are going up. Um, which is why most people will notice if they're going up each month, they are having maybe more side effects. that's, you know, fifth or sixth injection when they're starting the new dose is cuz they just barely reach therapeutic effect of the 2.5. And the reason that is is I'll kind of use like a step thing. So >> when you inject something, you get a serum steady state of 2.5 millig and then at the halflife, which is 6 days later, you have half of that left. And then you inject again and that compounds. So now you're actually at 150% of the original. And then the next halfife you're at you're at 100% plus 50% plus 25%. And then at the next halfife you're at 100% plus 50% plus 25% plus 12.5%. Right.

[00:05:37]>> So when we're up to like 10 milligrams we really have a lot more than that in our body.

[00:05:43]>> Yeah. Yeah. I mean it's not >> I've never heard it explained that way.

[00:05:47]>> It's not an exact number obviously but ideally yes. If you have a halflife and it's based on everyone's metabolism, right?

[00:05:53]For most people, the half life is 6 days of of tepatide. And so if you're 4 weeks into 10 milligrams, you actually have 10 + 5 + 12 or excuse me, 10 + 5 plus 2.5 plus 1.25. So you have 15 17.5 18.75 milligrams of trespide in your body, right? Um, and you don't really need to worry about that because that's the way the medications were studied. And so that you know based on that dosing that that's the effect that you're getting.

[00:06:25]But that's something that's super important to understand when we get into your question. And I know that was longwinded for everyone watching, but hopefully it was helpful to set up talking about micro doing versus split dosing.

[00:06:37]>> Yes, it was for sure.

[00:06:39]>> So, let's talk about split dosing first because split dosing um is a little bit easier to at least understand um based on those kind of pharmacocinetics that we talked about. So, if you're thinking about split dosing, um, and meaning you're you're instead of doing a once weekly injection, you're doing a twice weekly or a three times weekly injection. I would say three times weekly is very rare. Um, the reason that is is because of two reasons for most people. Number one, the trozepide halflife is 6 days, right? And so you can imagine that at as you're at days five, six or seven in that um progression, you may have more food noise, more appetite or things like that as the therapeutic amount is dropping with even if you're 5 6 weeks in and at steady state.

[00:07:32]>> And so some people have have found good success with taking that and splitting it into two weekly doses or two bi-weekly doses. Um meaning you know let's say you inject on Sunday then you inject on Wednesday or you know Monday and Thursday it doesn't matter and you're doing half the amount right so if you normally inject 20 units then you're doing 10 units and 10 units and the reason many people do that is either number one they're getting more um benefit by maintaining steady state concentration because like we said it takes five to six or three to four half lives to get there but then you still have to maintain that right and So instead of having a peak and a valley, you have a little bit more peak and valley here at higher concentrations because you're giving they compound, right? So if you're giving 5 milligrams on Monday and 5 milligrams on Tuesday or excuse me on Thursday, you're you're adding, you know, you know, 3/4 of the dose you did on Monday is gone, but you're adding on the dose that you're doing on Thursday. So people just basically get end up having more of this in their serum concentrations instead of this in their serum concentrations.

[00:08:46]>> So you keep a little bit more steady of a higher dose over a longer period of time.

[00:08:51]>> Exactly. And the cumulative dose is the same over that period of time. Right. Um because the half- livives are the same, the pharmacinetics are the same. Um, and so some people find better success with the appetite, the food noise, weight loss, those things. Another reason I see people split dosing is for side effects.

[00:09:12]So some people, they're like, "Hey, I'm at 7.5 milligrams and it's just not working well for me." Um, and I want to go up. And then they go up to 10 milligrams. And they're like, "Holy smokes." two like days two and three, you know, 24 to 36 hours afterwards, I am miserable. I am like my my stomach hurts. I'm nauseous. I'm bloated. I'm tired. And so I've seen that by doing the split dosing and not having as much as of peak and as much of a valley, mainly the peak, um people are having maybe more um predictable and maybe less severe side effects even though their serum steady state concentration is the same.

[00:09:58]>> Julie, that's actually what we're talking about right now is is the half dosing or like bi-weekly dosing. So that's actually what what he's talking about right now.

[00:10:05]>> Yeah, absolutely. So, um those are probably the two main reasons I see it.

[00:10:10]Um is either for the effect or for um the um the side effects. And I would say I personally do it. Uh you know, >> yeah, I actually just started doing it as well.

[00:10:21]>> Yeah. So, I micro dose a GLP-1 uh for food noise and um have had great success with that. You know, I I'm like my life has changed. It's honestly insane. Um, and I do, you know, Sunday and Wednesday, half of what I would do if I was doing it once weekly.

[00:10:37]>> I think one thing you just cleared up, at least for me, and I'm assuming a lot of others as well, is I think we all had this idea that you take your injection on Thursday, and then by the next Thursday, it's gone because I had that's kind of what I think a lot of people think is that it dwindles throughout the week and then by the time you get to next Thursday, you don't have any and so you need more. Um, but now I know that apparently it compounds on top of each other. Um, >> yeah. But it's ultimately to a specific highest.

[00:11:03]>> Yeah. Exa. Yeah. Exactly. Because I think a lot of people have that that thought process that it dwindles down and then and then you don't have any left. So one thing this pops in my mind because one question that I got actually several times yesterday on my TikTok live that I did was people that had hit that 15 milligram dosage and they don't have anywhere to go, right? 15 milligram sort of the highest dosage and they're either gaining weight or they're not losing any weight. So now I'm wondering if that split dosing schedule cuz again where do you go after 15, right? That seems to be a pretty a pretty a lot of people I'm see I'm hearing that a lot recently right now. So what would your advice be for somebody that's hit 15 and is either the one one woman yesterday had gained like 10 or 12 pounds over the course of a couple months and she was on 15 and she wasn't doing anything else differently. So now I'm like maybe she should split dose.

[00:11:55]>> Yeah. [gasps] Yeah. It's it's it's a great thing and I would say uh similar to how I preface most questions. I'm going to start with uh understanding why that happens, right? And so um I think many people worry it's like oh I'm just like uh I'm I'm tolerant to the medication which can happen but with GLP1 receptors we haven't seen the same as you would perhaps with you know a dramatic example like an opiate receptor. Um it it's just a different mechanism of response. And so with any weight loss and with any method of weight loss, you're going to have metabolic adaptation.

[00:12:33]So if I'm 300 lb, um, which I was, um, my resting metabolic rate is going to be much higher than it is at 200 lb. Um, whether that's 300 lb of muscle or 300 lb of fat, it's much higher. And so it takes calories to maintain fat cells. it takes calories to maintain any amount of mass. And so, um, it's important to recognize that like if your resting metabolic rate is 3,000 at 300 lb, it's and it's 2,000 at, um, 200 lb, you will get that decreased weight loss simply because of that, right? Because if you were eating 1,500 calories a day or 1,800 calories a day, you went from a 1,200 calorie daily deficit, which would cause you to lose like 3 lb a week to or two 2 lb a weekish um to then a 200 calorie deficit, which would cause you to lose a quarter of a pound a week, right? So even just recognizing that also the fact that most people no matter whether you're using a calorie deficit or using a GOP1 the you'll 25% of that mass you lose will likely be lean mass and muscle has a higher metabolic rate than um uh fat and so as you lose less muscle mass your resting metabolic rate goes down which causes that plateau where this is all getting to well why am I plateauing Why? Like I went to a higher dose. Why am I plateauing? And it's because as you have less weight to lose, you will lose weight much slower because your metabolic rate goes down. And you just have to have a certain amount of calories to have enough energy to survive, to have the energy to work out.

[00:14:18]And so I can tell you like from my personal experience um losing weight with just a calorie deficit and exercise, I lost 60 lbs the first year, 20 lbs the first year, the next year, 20 lbs the next year. Like it takes so much time. Um and then I've had to like put on more muscle. And so I would say for those people, yes, split dosing could be more helpful if you're noticing that those fi days five, six, seven, you are maybe having higher appetite. You are maybe having um more intake. Um but also recognizing that you know perhaps the insulin sensitivity and the gastric emptying effects could be um you know more steady with split dosing. So um with people who are at 15 milligs of traptide, it would be you could try split dosing. Number two, uh another thing to think about is your thermic effect of your food. Um and this is something I talk about with everyone when I'm talking about nutrition is everyone talks about protein and most of us talk about it in the sense of maintaining muscle mass. I would say that's where most people are at. There's a there's a couple other reasons to talk about protein. So protein number one has a 30% higher thermic effect of food. So when you think about what the thermogenic effect of food or thermic effect of food is, how much calories it takes to digest the food that you're eating, right? And so >> compared to fat and carbs, which are the three macronutrients, pro protein is actually much higher. So the higher amount of protein you eat, the higher amount of the calories in your resting metabolic rate are being devoted to digesting that food. So, not only are you helping with maintaining or building muscle, you're also helping with your resting metabolic rate because of the thermic effect of food. Additionally, protein helps with uh satiation. And so, it's kind of a three-point effect when I'm like protein, protein, protein, protein because it's like muscle, your satiation, and gastric emptying, but then also um the thermic effect of food.

[00:16:22]So adding in more protein and then obviously activity level is huge. Like we all have to be very honest with ourselves of like oh I'm working out every day or I'm doing this and I'm doing this and just saying like do I truly believe that my activity level is meaning there and that that sounds harsh and and I just recognize that like a lot of times we feel like we're doing everything we can do. Um and then the other is you know recognizing a stage of life that you're in. If you're in the bell circle community for for women's health or for GOP1's um you may have seen I've posted as well as commented on other people's posts about needing higher doses in >> uh parmenopause or menopause.

[00:17:04]And it's so interesting because estrogen has been shown to increase the amount of GLP-1 receptors available on cell surfaces. So, if you are in a low estrogen state either in at a point in your cycle um or menopause or pmenopause, you actually may need higher doses of GLP-1s to achieve the same effects that you would have at a different stage of high estrogen.

[00:17:32]Um, which I've seen clinically, like I've seen it so much where someone's in late permenopause or menopause and they're starting a GLP-1 and they're like, "I didn't feel anything till 7.5 milligrams." And I'm like, I'm not shocked. [gasps] Um.

[00:17:44]>> Huh.

[00:17:45]>> So, um, >> I talk all the time about Oh, sorry. I was going to say I talk all the time about people will people compare their dosing to other people's dosing and this just goes on to prove that it is so individual, you know, like why did Bob lose 20 pounds on two and a half and I gained three. Well, you're not to your dose yet. That's, you know, >> Yeah. No, there's a huge study in nature that did a huge genetic analysis >> and then they compared it to just observational data of just, you know, what was this person's sex, gender, age, and how much weight did they lose? And they found multiple misssense alals, which is simply just like a couple of amino acids were switched in a g in a gene sequence um in in GLP1 receptor expression. And they found that not only do women lose more weight, but women also have more uh side effects and they also tend to have more of the alals that code for more of those nausea, vomiting side effects.

[00:18:43]But then some people actually have a large amount of people have alals where they express less GLP1 receptors on the cell surfaces.

[00:18:54]So, super interesting and and like like you said, like everyone is different and you have to like and and you just have to accept that like you someone next to you that looks the same, maybe has the same BMI and the same age, >> they have different genes, they have different estrogen levels, like all those things.

[00:19:14]>> Yeah. I had a couple people yesterday in my live that were like, I'm getting ready to start to have it in my fridge.

[00:19:19]What's your biggest tip? And I said, "Turn off the internet because you're going to read so many different things from so many different people and none of it's going to apply to you or like a very small percentage is going to apply to you." Um, oh, so Christiey's asking which is more effective, adding estrogen or increasing your GLP1.

[00:19:36]>> I guess that's that's a broad topic I feel like.

[00:19:39]>> Yeah, that is a very broad topic and very personalized. I I'll say this, the doses for menopausal hormone therapy of estrogen are quite low compared to physiologic estrogen prior to pmenopause or menopause.

[00:19:53]And so I would say they're probably, and I say this all the time, I truly believe that GLP-1s will become firstline adjunctive therapy to menopausal hormone therapy um because of the metabolic changes and because of, you know, all these things we see. Um, so if you're not already on estrogen and you're parmenopausal and having symptoms, hot flashes, fatigue, brain fog, anxiety, irritability, all of the above. Um, talk to someone about it. Uh, hopefully me in a month. Um, and then yeah, like going up on your GLP1 if you're having more food noise, um, having decreased weight loss velocity. Um, but also understanding that no matter your dose, even if you were like very quickly titrated up to 15 milligrams and were losing a ton of weight, you will plateau. And plateaus are fine. Uh, and one thing I really try and focus on with plateaus is even if you're at let's say 220 for 6 months, which is a long time and it's could be very frustrating.

[00:21:00]There's a ton of fluctuation in body mass and if you're putting on muscle and you're and you're taking creatine and you're eating a lot of protein, you will having rap you'll and at what point in your cycle are you because you retain more water weight when you have higher estrogen levels as well. you will have all of that and then all of a sudden you'll drop five pounds. But it's the consistency of building the muscle, of losing the fat mass, of having the water be able to fluctuate to then do that.

[00:21:26]Um, and it's so frustrating for people and I've been in that frustration. I've been in that counting every calorie and at 1500 calories a day and saying, "Why the heck am I at 212 for 6 months?" That happened to me and then all of a sudden I dropped 5 to 10 pounds.

[00:21:45]the consistency.

[00:21:46]>> Yeah, I have a really good friend who she does Melissa, she does some videos sometimes with me here. We do like little little bestie chats, but she was in the 250s, 260s for like 6 to8 months.

[00:21:56]Like was on she takes 16.6 cuz she gets it through MoJi and she literally 68 months could not get under the 250s. She stuck with it. Now she's about to go under 200. Like it literally just started falling off again. But I I give her example a lot when people talk about plateaus.

[00:22:13]>> Yeah. No, it's great. And so like again to summarize I think split dosing is great being patient increasing muscle mass increasing protein um and there's so many other factors you know it's just like sleep cortisol insulin resistance all those things um can be so so helpful.

[00:22:32]Um, so let's shift gears a little bit though and talk about micro doing because Belle actually just launched micro doing. So I want to know like who could benefit from that and what the difference is I guess between that and split dosing and and all of that.

[00:22:46]>> Yeah, you know.

[00:22:47]>> Yeah, great qu, you know, great question and I think it's so important to recognize that like micro doing is a colloquial term. um you know it's not a true uh medical accepted term for most people and and also understanding that you could probably talk to a 100 different people and get a 100 different explanations of what micro doing means to them especially when it comes to a GOP1. For some people that means starting at a very low dose that's below 2.5 and titrating up uh to and staying below 2.5. Uh for many people that means starting at 2.5 and staying there. For many people that mean for some people that means doing a you know if you're on 2.5 you're doing.5 milligrams five times a week like it is all over the place.

[00:23:31]>> Um and in my clinical experience with micro doing where I have done it for PMOS and endometriosis I've done it for um uh pmenopause of course I've done it for food noise. I've done it for alcohol use um for the most part and the way Bell is choosing to to go around micro doing it is a less than therapeutic dose and there's an argument of you know is 2.5 or five the lowest therapeutic dose for tzepite we chose to stick with five there um and and for for multiple reasons but um basically anything less than a therapeutic dose that you're using um whether that's split dosing or whether That's um once weekly. It's using less than a therapeutic dose for goals other than weight loss. Um >> okay.

[00:24:22]>> And I think some people do experience weight loss with a deal with a micro dose. Um and I think that's totally fine. But I I think the tricky thing is the moment you start taking a micro dose expecting weight loss, then you're you're going to be disappointed, right?

[00:24:40]Um, and so, uh, I talk about all the time micro doing truly should be used for things that are not associated with weight loss. That's cardioratabolic factors, that's inflammation, that's per menopause, food noise, alcohol use, you know, things like that. Um, and there's some of those we have great data on and how they affect, and some of those it's more anecdotal.

[00:25:08]>> Gotcha. Um, so like how does Belle doing it or is it individualized? Is it like a everybody starts on this dose type of thing or are they how are they going about it?

[00:25:19]>> Well, it depends. If you ask the CMO, it's it's different and if you ask the COO, it's it's a different um No, it's so for most people it's going to be based off of are you already on a GOP1 or have you used one before or are you just starting? So, if you're just starting a GOP1 and wanting the benefits for inflammation, longevity, cognitive benefit, you know, with decreased risk of cognitive decline as you age, cardio metabolic factors, and you're just starting, you're going to be started on a low dose um uh of 2 milligrams and have the opportunity to go to three if you want to. Um that being said, I think given everyone knows at Bell, we take the patient experience so um you know it's so important to us and so if someone comes to us and say I want a micro dose but I actually want to start a half a milligram because I'm at a healthy weight and I want it for the for pmenopause hot flashes and to help with those metabolic factors. Those are things we work on with people every day, you know, even at therapeutic doses, right? And so um I think as it evolves and you know from a clinical standpoint I have worked on different pathways to basically triage like okay someone's this age this weight this BMI and this is their desired goal this is the titration they should take but for right now it is they're going to start at two and whether that split dose you know they can choose to split dose or not um and go up to three if they're already on a GOP1 and wanting to go down to a micro dose cuz they're like, I want to maintain my weight or hey, I'm at my goal weight and I want less food noise and I just want to maintain or I want to maintain the cardiumabolic benefit that I have. Um, then if they're on five or less, then they will give be given the opportunity to go down to micro doing.

[00:27:13]Um, gotcha.

[00:27:14]>> Um, and the obviously the huge benefit is just the cost, right? Right. I mean, $99 a month is so cheap. Um, and you know, very extremely competitive even in the micro doing. I think I see, um, a lot of competitors doing like$149 a month for micro doing.

[00:27:32]>> Um, and so, uh, we've chosen a very competitive price to make it available.

[00:27:37]Um, and so if you're already on a GOP1 and wanting to continue it because you reached your goal weight and you want to maintain your body uh fat percentage or you want to continue it for food noise, then you'll have be given the opportunity to then go from five to four to three to two um and kind of do that.

[00:27:57]And it's but it's very personalized. You know, if you message us and say, "I went down to three and I had more food noise.

[00:28:03]I want to go back to four or I'm on two and I have my my appetite's like too suppressed. I don't want that." Then we're going to work with you to to give you the proper dosing. Um because that's our goal is to make it very personalized. And my goal as CMO in the next 3 to 6 months is to create it to the point where you basically can have a personalized protocol that you know for the next 6 months I already know where I'm going. Like it is there's no more guesswork. Dr. Taylor already created a plan for me based off of my age, BMI goals, you know, um body fat percentage, and other uh health history. And that's really where we want to go is to be able to be able to offer that without any of the other BS that the other companies are doing. Membership fees, blah blah blah, raising prices, all those things.

[00:28:58]Like our goal is to continue to use the great team that we have at Bell to do that more effectively.

[00:29:04]>> Perfect. And I guess that you kind of answered Christiey's question already.

[00:29:08]Um she said, "If a person is on a GLP1 due to weight loss or metabolic disorder, won't that patient not be able to micro dose?" So he you kind of said no it you know if you're on five or whatever and you've hit your goal weight you want to go down then that's an option.

[00:29:21]>> Yeah. So five would be that sort of marker though where it would kick you into traditional dosing and traditional pricing and stuff. Is that what you're saying?

[00:29:30]>> Yeah. Exactly. I would say like five would be the marker and and again I would say for anyone who's coming to Bell and saying hey I want to take this for weight loss. Um it would we would be doing you a disservice to say micro dosing is a good idea. Right.

[00:29:48]>> Gotcha. So it would be the opposite way.

[00:29:50]People that were already on it that had lost weight they want to lose that then want to go down.

[00:29:55]>> Yeah. Exactly. And we have great data from the actual trials that shows like the surmount maintain trial showed that people who are on 10 to 15 and went down to 5 millig were able to maintain their weight so much better than people who um uh stopped the medication. And this is exactly the opportunity we want to give all of our clients and and patients a bell is like if you're on five to five to 10 and you know you're slowly going down because you're reaching your goal weight and feeling much better, we don't want you to feel like you have to stop because the cost is you know 50 to 100% more than the micro dose protocol. And so to be able to give you the micro dose protocol to be able to continue that long term was was a valuable thing for us to add for our patient experience.

[00:30:40]>> Yeah, I totally agree. Um, so we're going to open it up to questions now.

[00:30:43]Dr. Taylor has about 15 minutes left. He has some some consults going on uh at at whatever time it is your time. I don't even know. I do not keep track.

[00:30:53][laughter] >> Every time somebody wants to schedule something, I'm like, let me put that in chat GBT so we could tell me what time it is, [laughter] >> all the different time zones.

[00:31:00]>> Um, so one that I saw, so if you have questions, guys, start them with a question mark. But one that has popped up um is from HC Morin and she or he she I think says if you split dose will that wear down your receptors faster than if you were taking it once a week.

[00:31:15]>> Uh great question. There is no wearing down of your receptors. So and I think this is a common misconception uh amongst uh the whole GOP community and and is that um similar to like an opioid receptor where it's like you get desensitized to the medication. We just uh based on the data we have that just does not happen with GLP1 receptors likely because it is a a peptide receptor meaning or and and can also respond to small molecules right like uh funo which is the GLP-1 pill that just came out it's not a peptide it's a it's a it's a um it's a small molecule that activates a GLP-1 receptor and so um the receptors s that GOP-1 receptor agonists are acting on uh respond to small molecules and peptides. And so there's a de there's not a desensitization enveloping it into the cellular membrane um response. Meaning like with testosterone for example, if you have a lot of testosterone um that is triggering the hypothalamus, you'll actually get less receptors for testosterone in the hypothalamus to respond to. Uh we don't see that happening in GLP1 uh receptors.

[00:32:38]>> Interesting. That's probably a big thing you just cleared up there.

[00:32:42]>> Um, so [clears throat] Julie says, "Am I correct that you can't take Lily and compounded meds at the same time? I'd like to add a small dose on day five. My insurance covers the quick pen.

[00:32:56]>> Um, let me say this.

[00:33:00]Um, >> politically correct, Dr. Taylor.

[00:33:03]>> Yeah. um you are an adult and can choose to do [clears throat] what you would like to do. Um I personally would not recommend um you know changing around with that.

[00:33:15]If you do have the quick pen that allows you to change the dosage because the new quick pen allows you to to dial that.

[00:33:22]You can actually dial it to halfway and split dose with the quick pen.

[00:33:26]>> Yeah.

[00:33:26]>> Um so you can already you can already do that with the quick pen itself. um you just need to buy more pen needles, right? Um but uh I'm a big fan of of bell and compounding. So um and access.

[00:33:40]So, but um yeah uh short answer is tzeptide of any kind can be dosed multiple times per week and uh I do recommend using uh working with a physician to do that just because there are lots of people who you know the math is hard you know if you think time zones are hard you know just wait till you get into concentrations and milligram dosages and units and then uh uh half- livives and farmer coinetics. Trust me, that gave me the biggest headache I ever had uh in medical school. So, um yeah, definitely work with your physician.

[00:34:18]>> Okay. Yeah. And then adding on the fact that every com every pharmacy sent you a different concentration and you're so used to taking this, you know, the lay person so used to taking this units and now it's all a sudden different and all.

[00:34:28]Yeah. It's a headache.

[00:34:29]>> Um and we missed this question a little while ago. Emily said, "Is perry menopause an FDA approved condition label for insurance? And would there have to be studies to approve GLP1s for the condition for insurance to cover it as a first-line defense?"

[00:34:43]>> Oh, great question. Um, I'm assuming we're referring to GLP-1s and pmenopause and the short answer is no. Um there again is a study going on at the Mayo Clinic right now um for trappepides use in vasom motor symptoms of parmenopause meaning the hot flashes the night sweats the sleep disturbances and you know we anecdotally I have just have a ton of patients who um get that benefit um and so if that study goes through then there's an FDA approval obviously that will have to happen um long term but that takes years. So, um, yes, the the Mayo Clinic is doing a study and maybe that will happen.

[00:35:29]>> Hopefully that will come to fruition.

[00:35:31]>> Um, Sandra, you said split dosing also cuts side effects down and even completely eliminates them. And I have to agree with that. So, the whole reason that I started a little personal thing, the whole reason I started split dosing was cuz I can't freaking fall asleep at night. Um, and the Surmelon definitely helps me get restful sleep, but it doesn't help me actually fall asleep, right? And let me tell you, since I started split dosing, I'm falling asleep every single night within, you know, 30 minutes or whatever when I lay down when previously was like 2 hours. So, I agree that it that it definitely helps with with side effects. That was just a little that wasn't necessarily a question, but um >> yeah. No, I agree. I think there was a lot of questions early on. I'm going to scroll up and just see if there's any good ones.

[00:36:09]>> Yeah, there was.

[00:36:10]>> And Britney, if you see one, just shout it out.

[00:36:13]>> Okay.

[00:36:15]Yeah, there was a lot at the beginning.

[00:36:18]Looks like a few of them we we covered pretty pretty well actually. Let's see.

[00:36:24]Um how low of a dose do I micro dose? Um I do um about one and a half twice a week.

[00:36:37]Um Chrissy, I don't know if if we touched on this or not, but she said, "I forgot to ask in our consult. If I've been in a plateau for over three months on troeptide, could it be that my estrogen my estrogen fluxing or could it be just because I've lost 100 pounds, which probably both, right?

[00:36:52]>> Yeah, we answer. Yeah, that I was like, "Yeah, we we did a good job answering those ones."

[00:36:56]>> Yeah. Yeah, I think so, too.

[00:36:58]>> Um [clears throat] >> a couple people saying that insurance is making them increase, which is kind of a bummer.

[00:37:04]>> I know it is. So, yeah. So, um, a lot of the pretty much every insur commercial insurance, you know, having worked as a primary care physician in this field, um, pretty much every commercial insurance over the last few years has if they're not covering GOP ones or excuse me, if they are covering GOP ones, they're finding every reason not to. Um, which to me is hilarious because I'm just going to go on a tangent here because, you know, I'm Go ahead. Just I'm getting fired up. Um, it's hilarious to me because it's like when you I've worked in as a hospitalist and as a primary care physician and I see the amount of hospitalizations that happen due to obesity related conditions and metabolic disease related conditions, heart failure, kidney disease, diabetic, you know, neuropathy, DKA, like there are so many chronic conditions that result in high like utilization of health care need, health care resources and costs that are related to obese.

[00:38:00]obesity and metabolic syndrome. And if all insuranceances covered 100% [snorts] of the cost of a GOP1 from the um manufacturers at even $1,000 a month, five years from now, if everyone, you know, was able to use them to make the lifestyle changes they did and because they can um they do, we would see a like a billions of dollar decrease in healthcare utilization and they would actually end up saving a ton. ton of money.

[00:38:33]>> Um, yeah. And I've seen people hospitalized for liver transplants because of fatty liver disease, because of obesity, right? Um, >> so it's just hilarious to me because I'm like, I don't know how these smart people that are, you know, the head financial people for insurance companies aren't doing this, but I'm also like, you know what, Belle's going to do it and we're going to crush it and we're going to make sure that you're all taken care of.

[00:38:54]>> It's it's I think there's a reason behind everything, right? And I think that reason ultimately is money and but but you said it would save them money, but I Yeah, you're right. I don't understand that it either, but >> sometimes it makes me wonder if they really care about our health at all.

[00:39:08]>> Yep. The the short answer is they [laughter] >> plot twist. Um, okay. Christy asked, "What were the the pharmaceutical reasons for not sleeping?"

[00:39:22]>> Yeah, >> we're women and we're getting older.

[00:39:25]>> Yeah. I mean, Britney, you're how old?

[00:39:28]>> Almost 38.

[00:39:30]>> Yeah. So early >> I've been for you know maybe TMI but I've been menrating since I was nine so I'm kind of in that >> thing.

[00:39:41]>> Yeah. Um and you know when did your mom go through menopause? Do you know when she started?

[00:39:46]>> Around 40. And my grandmother too.

[00:39:49]>> Yeah. It's very genetic.

[00:39:51]>> Yeah. every everyone who's watching, if you're a woman in your 30s, go ask your mom and your grandma when she stopped having a period or when she started having permenopausal symptoms cuz that's probably about when you will. Um the question was though um the sleeping so >> both trespatite and the new triple agonist redotide are linked with a higher HRV or excuse me a lower HRV u and so less heart rate variability but higher resting heart rate and so um uh the mechanisms are much different you know ratitude has the glucagon receptor agonism but trespide um has been shown to increase resting heart rate. Um, and so just by increasing that resting heart rate and increasing that response and insulin sensitivity, which insulin sensitivity has a high interplay with um, sleep, you could potentially um, be having difficulty sleep because of that higher resting heart rate. Your your heart rate, there's two things that have to drop in order for you to fall asleep.

[00:40:54]Your heart rate and your temperature.

[00:40:56]your temperature has to drop by it's like a half to two degrees and your heart rate has to drop by like 5 to 10 um before you can actually fall asleep.

[00:41:08]>> Interesting. I didn't know that. Um couple more questions here. We got a few more minutes. Um >> yes, >> I saw a question about that I was going to go back to and now I've lost it. Did you have did you see that pop up?

[00:41:22]>> Yes, I did also see it. Let's find it. I have two more minutes. So, everyone send in your rapid fire questions and I'm going to go off and then >> and then bring >> I think it was somebody that was on Morland and C something and they were having like a a flash like they weren't falling asleep. It was something to do with that.

[00:41:39]>> Oh, yeah. Flushing is is is definitely uh it can be a side effect of CJCFl and I talked to everyone about this is like the most common side effect is flushing.

[00:41:50]Um and if you're having it significantly half your dose um and um it can increase your resting heart rate as well for the 3 months that you're on it. Ideally though because it activates the growth hormone, it actually increases REM sleep and deep sleep and recovery and all those things.

[00:42:09]Okay. Um, sunshine, we kind of we kind of talked about that earlier. He said, "We're adults and we can do what we want." So, if we want to supplement with this compound, you know, do what you want.

[00:42:19]Um, uh, hold on. If you're not having symptoms, how do you know if you're in menopause?

[00:42:24]>> Great question. Uh, you'll know. Yeah.

[00:42:26]Um, I mean, it really it can start as early as 35, around 40 for most people.

[00:42:32]The most common symptoms are going to be, you know, new anxiety, brain fog, irritability, joint pain can actually be one that can be a first presenter.

[00:42:40]Vaginal dryness, uh pain with sex, um fatigue, sleep disturbances, racing thoughts at night is very common.

[00:42:49]I think I saw I can't turn my brain off to sleep at times. Yep. Very common. Um >> I think that's why we can't fall asleep.

[00:42:57]>> Yeah. And it's why menopause has been sorely overlooked for so long is because the symptoms are all over the place. And unless somebody is savvy enough to ask you about more symptoms and to look at your age and your risk, you're probably not being asked.

[00:43:10]>> Gotcha. Um, okay.

[00:43:14]Rea, how long do you think it'll take to be a FDA approved? 2027, I think, is what's projected right now. Yeah, we thought it was going to be this summer, but um I think with all the other things happening with peptides in the FDA, which um I'm going to be doing a YouTube live on Wednesday to talk about >> It's this week, right, that they're supposed to meet about that.

[00:43:32]>> Yep. It's it's Thursday and Friday that they're meeting about that. So, on Wednesday, I'm going to do a YouTube live and just talk about all the the the perceptions and what the FDA has already said and what the committee's already said and what's going to happen and talk about a little bit of my insights as um someone who has some connections with people high up in the federal government and uh what they're saying about it. Uh it'll be a really fun one to talk about.

[00:43:58]>> Yeah. Share it with me and I'll share it everywhere so that can hop in.

[00:44:01]>> Absolutely. I'll schedule it. Yeah. put it in the uh put it in the the description of this live and I'll I'll make it right now and send it to you.

[00:44:11]>> Okay. And then final question because I know you have to go. What's the most helpful peptide for sleep and hot flashes?

[00:44:17]>> Great question.

[00:44:17]>> Used in conjunction with >> um other than tur [laughter] >> um >> the the uh I just Oh, you know what the other thing I'm going to do, Britney?

[00:44:26]I'm going to send you three things. I'm going to send you that. I'm going to send you the landing page for my peptides and perry menopause ebook which I finished last week.

[00:44:35]>> I'm so excited for uh and so for all of you who are asking questions about peptides and permenopause, I made a 40page ebook that has >> all of my thoughts on all the different peptides that can be helpful and when they can be helpful um in conjunction with menopausal hormone therapy and GLP1s. I think this is the most valuable resource I have made to date. Um, and so >> I'm going to send those two things over to you. She'll put them in the description of this live. It'll have both the um the live that I'm doing on Wednesday about peptides and the FDA and all those things and then the peptides and parmenopause. But the short answer is CJCarellin is definitely my go-to.

[00:45:17]Um, it's more mild than tesamearellin.

[00:45:19]It's slightly more effective than serarellin or powerful than serarellin.

[00:45:23]Um, and because of that effect on growth hormone and deep sleep, it's so helpful.

[00:45:29]Um, I've got to hop off for consults.

[00:45:31]Uh, live vital.io/cconult if you want to talk about.

[00:45:36]>> Oh, beautiful. Um, and I will send you those other two links, Britney to put in the description. Thanks everyone. Uh, always happy to be on.

[00:45:44]>> Thank you.

[00:45:48]>> If I can figure out how to get off. I don't know.

[00:45:52]Okay, Dr. Taylor's gone. Um, if we have anything else we want to talk about here, I am really excited for that. Um, the ebook, I think that's going to be super helpful. I was not even aware that he was doing that. So, I'm pretty excited to share that with you guys. So, as soon as I have the link to his live for Wednesday and the ebook, I will add them to the description. I'll post them on Facebook. I'll post them everywhere.

[00:46:18]Um, but that ebook is definitely one that I am going to want to be reading.

[00:46:22]Um, yeah, and my Monday video just went up as well. I originally was going to post it at 10:00. I switched it to 11:00. So, go watch that now. Um, but thank you guys all for for joining. Uh, Dr. Taylor and I will do another one very soon. Um, and talk all about all of the things. So, be on the lookout for all that stuff in the in the description box and I will u share them over on Facebook and I'll make a community post as well. Okay, guys. I hope you have a great start to your week, a great Monday. Um, and I will see you very soon. Have a great day. Bye.