Dr. Ade
Welcome to the Modern Midlife Collective podcast. The place where we get unapologetically real about thriving in midlife health, hormones, and everything in between.
00:12
Dr. Jillian
I'm Dr. Jillian.
00:13
Dr. Ade
And I'm Dr. Aday.
00:14
Dr. Jillian
Together we're your guides to navigating this powerful season with confidence, strength, and the wisdom you deserve. Welcome to the Modern midlife collective. I'm Dr. Gillian Woodruff, a board certified gynecologist, college cosmetic gynecology surgeon, a sexual medicine expert, and a nationally certified menopause provider.
00:37
Dr. Ade
And I'm Dr. Aday Akin to pay family nurse practitioner. I help women navigate weight loss, hormone balance, and sustainable wellness so they can reclaim their energy and confidence during the season. That's often misunderstood.
00:49
Dr. Jillian
So today we are diving into something that on everyone's social media, I know that everyone is coming into my office asking about this, what I think, should they be doing it? Yes, we're talking about GLP1. So these are medications, usually injectables like Ozempic and Wegovy and Manjaro and Zepbound. I know you've heard of them. You've probably been a little bit curious. You may have been on them already. And issues have been arising like really limited supply or the change in who. Who gets this covered by their insurance and who doesn't. And is this for weight loss or is this for diabetes? Can it be for both? So I would like us today to talk about this and just try to figure out what's real and what's hype.
01:41
Dr. Ade
Yes, we definitely need to break it down together because these medications are changing the landscape for weight loss. So I think it's expanded in popularity because post pandemic, we saw all the things that were happening right from years or a couple years of us being sedentary, not going to work, just being faced with food all the time. Maybe were even using it to cope. So coming out of a pandemic and now having these medications, it was a perfect storm. So for us to sit down and talk about what's really true, what's not true, and what do midlife women really need to know about before making decisions to go on therapies like this. So they're a household name, you know, of course you mentioned some of them. Ozempic, Wegovy, Mounjaro. But some people don't realize that these medications are not very new.
02:29
Dr. Ade
They've been on the market for a while. There are different versions of them. There are the ones that are oral medications. But then we've perfected it so much that now We've got ones that work more effectively. There are some that actually are daily injections that are used for type 2 diabetes, not for weight loss. But one of the side effects of these medications is the weight loss. So with these medications, which we call glp, essentially what they do is curb your appetite. You produce the hormone, the GLP to reduce your appetite. So it's a side effect, weight loss, you lose about maybe 20, I think maybe max 30% of your body weight. Some people even lose a lot more. So it really depends on your body.
03:11
Dr. Ade
And of course, if you have the perfect storm of your nutrition, hormone balance, all those other lifestyle things, you could probably do a whole lot more, but it's a great tool. So women are navigating menopause or perimenopause. I often tell them it can be a situation where if you're not starting to discover how your body uses sugar, as you start to lose your hormones, it can be the perfect storm for high blood sugars. You lose your estrogen, inflammation goes up, and you start to get things like belly fat. You're doing all the things, but you're not seeing your weight moving. It's like, I'm eating less, I'm moving more. How come I'm not seeing anything? So that's where these medications can be very helpful. And I know that there is a lot of stigma out there.
03:55
Dr. Ade
I remember reading a post on Facebook that was bashing someone for losing weight on a glp and it was thought to be, oh, she's taking the easy way out. But obesity really is, as you know, Dr. Jill is a chronic condition and this is not something that you use to treat. You know, a five pound weight loss, a ten pound weight loss. This is for people who may have struggled their whole life. Some people, maybe as teens, they realized something was wrong, but they really didn't know what. And sometimes it might be due to hormone imbalance. It can be a genetic obesity. I remember attending a conference last year and we found out that there was a rarer thing for kids. Actually.
04:33
Dr. Ade
There's some physical things that you notice on a child, and those are usually, I think it was abnormal fingers and ears, the way they look. And I was just very fascinated that for years maybe that child was teased because they thought he just eats too much or he's lazy and that's the stigma. It's like you have this weight on you and it's, I'm just overweight because I eat too much. But it's not. We're knowing more about it now. That it's not just eating less and moving more. So these tools, and I call them tools because that's all they are, is to help reduce the risk, especially for women, you know, heart disease. You know, women are at risk for heart disease, high blood pressure and stroke. So these medications reduce those risks.
05:14
Dr. Ade
So it's a reason why it's a part of what we use during this time to help get that weight down.
05:20
Dr. Jillian
You unfolded so many things there. First of all, like this medications were created for diabetes. And then did they just notice that people were losing weight and so they started to apply it to that as well, Correct?
05:34
Dr. Ade
Yeah. So it wasn't really initially meant for weight loss, but I think these drug companies now saw that and said, okay, well, we need to take a step further. Now they've released WeGovy, and then now we've got Zepbound. And now we're finding out that, you know, there are certain things we're starting to notice that are improving, like lower blood pressure, lower A1C. Now we're giving it to people that have sleep apnea. I think zepbound is now FDA approved for people that have sleep apnea. So we're realizing that GLP1s do have benefits. It's not just weight loss, but reducing the risk of chronic conditions. So we're still trying to catch up. I think the insurance companies are probably starting to catch up with, hey, how about we approve these medications for these things so that they don't end up needing multiple medications later on anyway?
06:24
Dr. Ade
That's a whole other story.
06:25
Dr. Jillian
Yeah, that goes back to what were talking about in previous episodes about sick care versus preventative care. And so, yes, it would make more sense to provide you a medication that would prevent you from having these chronic illnesses. But our society is structured a little differently in that we are going to treat those illnesses at a much higher cost later down the road. And that is an issue with these medications, is that they can be approved. But even with diabetes, sometimes they're wanting you to try other medications first, and then with obesity, sometimes have insurance coverage for obesity. And even if they do, this particular medication may not be covered. And I've also noticed in some that it is covered, but they still have a bill, 500 to $800 a month, which is really just a ridiculous amount to spit.
07:19
Dr. Ade
Yes, it is outrageous, and it is a daily struggle. And it's part of the reason that I tell patients all the time, you know, they'll say, well, it is covered. And I'll say, call your insurance and find out, because oftentimes it's covered for diabetes, type 2 diabetes, specific diagnosis. Even if you do have some weight to lose, there's a lot of criteria that you have to meet to qualify for having that drug. And even if you qualify for that drug based on those metrics, your insurance plan from your employer may not have it on their formulary. So that's something that you have to deal with. It's FDA approved. Yes. You meet criteria, but does your employer cover it?
08:00
Dr. Jillian
Yes, that's right. I have a question for you about these medications. So you mentioned, and you know, we've talked about in the past, that there are other issues that may play a role in why somebody may not be able to lose weight. So let's say it may not be that they're eating too much and not moving enough. We see women and men who are exercising and they are following special diets. They just can't seem to lose weight. Sometimes we find there are hormonal issues that are preventing them to losing weight or kind of obstructions. So with these medications, if this is something that decreases blood sugar, but it's an appetite control, does this work then for people who maybe do not have a problem with the amount of food they're taking?
08:48
Dr. Jillian
And if it does, then are we just making it so they're eating very little and then having also loss of muscle, loss of bone density?
08:58
Dr. Ade
So that's a great question. So one of the things we start with when we coach patients is discovering what is the underlying cause. Because when someone walks into the office and says, I've been dealing with this problem my whole life, it's not uncommon to hear that. That's my first clue that there's something else going on. Often when they lose the weight, they gain it right back. I had a lady the other day who had gastric bypass and gained 100 pounds right away as soon as she was done with that surgery. So it is so multifaceted. Sometimes if there's post traumatic trauma and food is used as a tool to deal with it. There's a lot of psychological aspect with obesity and weight gain. How food as nourishment is it a way for you to celebrate is the cultural thing.
09:42
Dr. Ade
So it's really important to have that aspect addressed before even considering going on a medication like that. And the reason why I say that is sometimes when you start a medication without addressing the root cause, it can actually backfire. Now this person is feeling like they need to be on this medicine for things to work well. So it's a psychological thing. Do you really need to be on this medicine? I have many people who are doing excellent without being on a medication like glp. So I think you need to figure out why we do a questionnaire. Do you have habits of eating late at night? Is it a binge eating disorder? You don't want to treat a psychological problem with a glp, right? So why it's important for you not to seek help from all these.
10:32
Dr. Ade
There's a lot of different places that are offering these medications. You can get them compounded. You can just go online and get these medications. The compound in ones was, I think somebody said that $99, but you're not getting the proper guidance. Like you said, you can be losing muscle mass and you're losing weight, but you're still actually more unhealthier than you were before. So it's a really holistic approach, especially if you're gonna use it as a tool, because at the end of the day, the whole goal is to make sure that those habits have been addressed. We have a way of getting past them. And it's always a revolving thing, right? It's not a linear process, especially if it's been a problem for so many years. It's not gonna just stop overnight.
11:11
Dr. Ade
Whether you're with me for three months or six months, it's a revolving process. There are gonna be days that you're not gonna eat well. You're not gonna eat a hundred grams of protein every day. You're not gonna exercise every day. Right. But the bottom line is that you've figured out what your patterns are. One of the reasons I encourage journaling, because often you'll see the patterns of eating. And if eating is not a problem too, maybe it's a metabolic issue. Do you have nutritional deficiencies in your diet that's causing you to gain weight? Do you have food insensitivities? In my case, food sensitivities was a huge part of why I had gained so much weight. Growing up, eating certain things, you know, the way I was managing stress, all of those things, what caused me to gain weight.
11:54
Dr. Ade
So when I removed those things, and I'm still constantly working on them right now, I didn't go anywhere overnight. It's working progress. So that's why I think it's important when you're trying to start medication, make that be the tool. And I always emphasize when they ask me, well, what about that medication I'm hearing a lot about? I'll say, what medication? Oh, the Wegovy. Well, let's put that aside for now. Let's talk about you. I think once we clarify that people are able to see where we need to make some changes and then maybe being on a GLP can help you because it's very motivating. Right when you start to see the weight coming, especially if you've been trying for so many years and nothing is happening, or you gain the weight and you lose the weight and it comes right back.
12:38
Dr. Ade
So it's a great medicine, but should be very cautionably used.
12:43
Dr. Jillian
That's right. And I think another important thing that you brought up was about compounded products. In using compounded semaglutide and you're getting this online, you're not actually, you know, even meeting the people sometimes or having real visit. And I think we have to be careful. So not that compounding is bad, have things compounded all the time, but you want to know more about the pharmacy that you're having things compounded at. There are other forms of, let's say semaglutide. So compounding pharmacy is a pharmacy that may take the active ingredient. So if it's something like the brand name is Amphic, the active ingredient is semaglutide. And so they take that active ingredient and they will put it into the form you're using it. So they'll put it into an injectable product.
13:33
Dr. Jillian
You can put things into tablets that you take by mouth, you can put things into creams. But that product, that semaglutide, that active ingredient, there are different forms of this. So there are these, I think they call them salts like semaglutide sodium or semaglutide acetate. These are not FDA approved forms of semaglutide. Some of them may be just a research based form that isn't FDA approved. And so you actually may not even have the results that you think you should have, or you may have side effects. Even with the real medication, you can have side effects, but your side effects may be different based on the type of product you get. And so I think that's why it's important to see a provider, like somebody who is responsible for you, that knows your name outside of that business. Right.
14:26
Dr. Ade
Compounding pharmacies actually have been a saving grace for a lot of my patients. Unfortunately, they don't qualify for them and they want to lose this weight so they don't get sick. I will prescribe from a compounding pharmacy. What I also like about it is there's more flexibility with dosing because some People, if you get it through your insurance, you really don't have that option of staying at a particular dose because it's your insurance paying for it. Right. So there is a little bit of flexibility with dosing, especially if you can't tolerate the side effects. You can stay at a lower dose if it's helping. I actually encourage it to stay at a lower dose. If it's working and there's less titration needed, you can use that as a little, a crutch, if you will.
15:08
Dr. Ade
While you start to build those other symptoms, build those other, you know, the things that you're supposed to do in life. You know, sleep well and exercise, all those lifestyle things is important. It's actually the pillar that's going to get you where you need to get to over time. Because your body's set point really needs to adjust as you're losing weight. You don't want to lose weight so quickly that your body starts to feel like, oh my goodness, I'm starving. And then that's where sometimes you get stuck. You don't lose any weight because your body feels so stressed. So most times say don't. If it's working, why do we need to keep titrating up? Because people think the higher the dose, the more weight they lose. And it doesn't necessarily work that way all the time. Some people only need a little bit.
15:53
Dr. Ade
Remember, it only suppresses your appetite. It doesn't burn fat, it doesn't do any of those things, but keep you full faster.
16:00
Dr. Jillian
Yes, that's right. I mean, that's a lot of great information. Maybe you can just tell us about some of the side effects that people may experience with these medications.
16:10
Dr. Ade
Yeah, most of it is stomach related. Right. Because it's working in the gut. It kind of tells. The brain talks to the stomach and the stomach kind of gets full. And if you try to. Even if you see the food and you really want to eat more, you just can't. And if you try to do it, you could get sick. So nausea, vomiting, constipation, maybe even diarrhea. I see this more in the wegovy and nozempic more than the Zepp down in Mounjaro patients. I'm not really sure if that just anecdotally, that's just what I see more of that I have seen some people, very rare, complain of fatigue. Some people even depression. Again, this is working. It's a gut brain thing. So you can imagine if it's working on the brain, there might be some effect in some People.
16:59
Dr. Ade
So if you have some mental health things history and you're noticing your mood is changing, that might be something to talk to your provider about. It might be the medication. The other thing is if you are not eating enough calories, I've seen people that would say they lose hair. So if you're not eating enough, you're not getting your protein in, you're losing muscle because you're not getting enough calories in. So you need to make sure that you are nourishing your body. Cause even if you're losing weight, you still need to make sure that you're eating those great macros, great micronutrients that your thyroid needs, that your hormones need to function. So those are the most common. I'm sure there's probably a lot out there that are not as common, but those are the ones that I see most often.
17:39
Dr. Jillian
You know, I forgot about that when were talking in the past about hair and skin. But yes, especially now I am seeing so much more shedding of hair with these medications. And the way you mentioned fatigue and could that be part of this or not? Is this a symptom of taking this medication? And I think all of it is just like what you said. We have to pay attention with the other things that we're doing. So if we have appetite suppressant, are we getting the protein that we need? If we don't have the protein or we're not bringing in enough calories to support our bodies, even at rest, then we're going to feel tired and you're going to lose hair if you can't support your basic fox function.
18:21
Dr. Jillian
So some of them may not be this is from the medication, but it may be from what you're doing aside from taking that medication. Well, what about microdosing? I'm hearing a lot about microdosing. Just taking small amounts of this medication for maybe other purposes other than weight loss.
18:40
Dr. Ade
So that's something that I've experienced it with patients and that's pretty much how I practice anyway. It's like he, let's stay at this dose. It's safer, it's working. I can't say that there's any solid research to say this is a thing, but I have been following a lot of medical providers out there who have also noticed a difference in terms of reducing inflammation. It helps even people that have things like alcohol issues or smoking issues. It's just amazing how we're seeing some kind of a correlation. They have a reduced want for alcohol or for smoking. I've seen things like Maybe for drugs they have that lower affinity for wanting to go doing those illicit drug use. So there is a lot we still don't know about these medications.
19:29
Dr. Ade
But I will tell you from my clinical practice that even being on that medicine at a lower dose for people who really do have obesity, I've seen reduced blood pressure, all those markers for cardiovascular disease. Heart disease, their blood sugars are more stabilized, their gut health is better, they're eating better, they have more energy. So again, this is not something that is like, hey, microdosing is a thing. It's really evidence based. We've done robust studies on, but we're seeing it from practice that it can be. So yes, I definitely prescribe it for patients.
20:05
Dr. Jillian
Do you agree with that inflammation picture? I've seen so many people who had such a of the complaints actually from perimenopause of the joint pain, which is somewhat due to inflammation. And we know that in perimenopause we do have higher inflammation from that fluctuation of hormones. So this is a space for this to come in. Yes, I think so, yeah.
20:29
Dr. Ade
Especially microdosing, the hormone replacement with it. And it's like you balance out the hormones, maybe they were having estrogen loss and you replace that, you put them on that calming progesterone, testosterone and it's just like they're a new woman. It's amazing. It encourages them also because now they're not as fatigued right now. They've got muscle mass, they've got their testosterone, their muscle mass is better and they actually want to go to the gym. They have the get up and go do the things that they want to do. So it's been a game changer for women in perimenopause. Definitely. If this is something that would benefit you, I think talk to a provider about it.
21:06
Dr. Ade
I will say though that it's important to know what your medical history is because if you have medullary thyroid carcinoma, which is a specific thyroid cancer history or family history, this is something that you might want to talk specifically and see. This might be a good fit for you. But that is one of those contraindications for all of the GLPs, whether it's Zeppelin, Ozempic, all of them. Not that if you have hypothyroidism, this is completely different. I've heard someone ask me about that, what if I have a low thyroid function? That's not this. This is a particular type of cancer that you probably don't want to be on that for.
21:38
Dr. Jillian
Even if you've had other forms of thyroid cancer. That is a great distinction to make. And medullary thyroid cancer is actually very rare. In the studies, they actually found this in rats, so wasn't reproduced to my knowledge in humans. And I think the cell that the rats have and their thyroid, humans actually don't have. So I don't actually know for sure if this is something that would happen for humans. However, we know that when we are doing research for these medications, they have to be very strict. And so even if this would not happen in a human because this happened in rat models, they have to put this contraindication in there. But thank goodness it is a very rare cancer to have.
22:21
Dr. Ade
Yeah, I'm glad that you brought that up because I have seen some people turn it away and it would be a great option for them. But once they see that, it's like they're thinking they're gonna get cancer from it. This is, again, I'm so glad you said that. It doesn't mean it's not for you. When you're on it and you're closely monitored, it's safe. Of course it does have. Every medication has its side effects, but you wanna minimize that. You don't want it to be overt, obviously. Right. But it's a great medicine if it's a good fit for you. Again, it's a low risk of this happening. It's very rare. So if it's something that's good for you, ask your healthcare provider.
22:54
Dr. Jillian
That's right. A few things to recap. You just said there's risks to everything and side effects to everything. There's risks to not doing this medication, risk to doing the medication. So is this a side effect that I am willing to accept or I'm able to physically accept? Those are things that you have to remember. And then also they say that this is magic.
23:13
Dr. Ade
Right.
23:14
Dr. Jillian
But there's no true magic where things will happen overnight. So we have to be patient with our bodies and. And then thirdly, seeing a provider that can put this whole picture together for you, and I wouldn't settle for anything less. It is a whole body transformation that you want to happen, especially when it comes to weight. And there's not just one thing that is going to give you everything that you want. And also when you're thinking about these places online, there's. I understand where a lot of them come from because they're trying to fill. Feel a need that they fills a gap where people don't have access to medications and providers that they need the Danger, though, in this is that you do not know where these medications come from.
24:04
Dr. Jillian
If you have a product that's $99, that's probably not the real product, they could actually be having other side effects in your body that are not acceptable. So you want to go to somebody that knows where the product came from. They know the pharmacy, they know of that pharmacy. How it's state regulated, FDA regulated, what it is, if it's a sterile compounding facility, because you're injecting this product into your body. So you want it to be a sterile product that is regulated. So. And not just that. She said it's the full body. So Dr. Aday is talking to you about your nutrition, your lifestyle, this medication, how to mitigate risks with the medication.
24:50
Dr. Jillian
And then because she knows the medication and knows you can look at these may be more common side effects, how can I decrease your risk for those side effects as well?
25:02
Dr. Ade
Absolutely. If you're on these meds and you're not losing weight, I think it's important to consider, you know, do I need this medicine? That might be the first clue that this is probably not the right tool for you. Are you working with the right provider that's looking at the root cause and not just saying, here is a prescription. I think again, insulin resistance is a huge issue if you're on medications like insulin, too. Insulin can also drive weight gain. So cortisol, if you're not sleeping. Dr. Joe talked about thyroid. So sustainable weight loss is not just prescription. It really is about working with your body right now, especially as women going through these hormonal changes and not against it. So, Dr. Jill, I'm so glad we got a chance to really open up about this conversation.
25:44
Dr. Jillian
That's right. And if you're feeling confused by all the messages that are out there, you are not alone. That's why we created the Modern Midlife Collective. That is exactly why it exists, so that we can dive into these important topics and answer your questions and let you know that you do not have to figure this out alone.
26:04
Dr. Ade
That's right. Thank you all for being here today. If this episode helped you, please share it with a friend or tag us on Instagram. Rjillianwoodruff and R ade Akindepe let's keep having these honest conversations, empowering every woman about what it means to be in midlife. Remember, you're not broken. Your body is just asking for a different approach.
26:27
Dr. Jillian
I like that. Be sure to subscribe. Follow us at the Modern Midlife Collaboration Collective and we will be back with another real empowering conversation to support your midlife wellness journey.
26:40
Dr. Ade
Thank you for tuning in to the Modern Midlife Collective podcast. We hope today's episode has inspired you to take bold steps towards thriving in midlife.
26:49
Dr. Jillian
If you loved what you heard, please leave us a review and share this episode with a friend who's ready to step into their power.
26:57
Dr. Ade
We'll be back next week with more insights, strategies and real talk to help you live your best life at any age.
27:04
Dr. Jillian
Until then, remember, thriving at 40 and beyond isn't just possible, it's your birthright. We'll see you next time.