Joey Wahler (Host): It can help fuel weight loss. So, we're discussing GLP-1 medication. Our guest is Courtney Neal. She's an advanced practice registered nurse and family nurse practitioner. This is WickCare Talks, the podcast from Wickenburg Community Hospital and Clinics dedicated to helping our community live healthier, more active lives.

In each episode, we connect you with trusted health experts to share valuable insights on a wide range of topics. From managing chronic conditions to simple tips for everyday wellness, we're here to provide practical information to support you on your health journey. So, be sure to follow us so you never miss an episode. Thanks so much for being with us. I'm Joey Wahler. Hi there, Courtney. Welcome.

Courtney Neal, APRN, FNP-C: Good morning, Joey. Nice to see you again.

Host: Same here as always. So first, in a nutshell, for those unfamiliar, what are GLP-1 drugs and how exactly do they contribute to weight loss and overall health?

Courtney Neal, APRN, FNP-C: So, GLP-1, GLP stands for glucagon-like peptides. So if you remember from our peptide conversation that we had recently, these are basically signals to the brain. So, these medications signal the brain and tell the brain that it's full. You don't need to eat anymore. So, there's a couple of different kinds—well, there's several different kinds, but the two main kinds that are really the ones that we're hearing about the most publicly right now is semaglutide and tirzepatide. So, we've got Wegovy and Ozempic, those are going to be the semaglutide. And then, tirzepatide, its Mounjaro and Zepbound. So, we have these medications not only from manufacturers, drug manufacturers that are prescribed by providers, we also have them compounded that we can get from compound pharmacies that have this main ingredient in them plus B12 to help with fatigue and nausea, and glycine to help with maintaining muscle mass while you're losing weight. So, widely available.

Host: Absolutely. And so, what's the science behind GLP-1's role in weight management in simple terms,? What's going on there?

Courtney Neal, APRN, FNP-C: In basic terms, it regulates hormone production, telling the brain that it's full, reducing cravings, ultimately leading to reduced calorie intake. And they also slow down gastric emptying. So, your gut is always moving and every time you eat, it moves through the gut takes the nutrients out, does its job, right? So when we slow that process down, we feel full longer. So, that's why I tell patients immediately the second that they start taking these shots, they have to cut their portion sizes in half, or everything's going to sit like a lead brick right In their gut. They'll just be miserable.

Host: Nobody wants that, right?

Courtney Neal, APRN, FNP-C: No, not at all.

Host: Right. So, how exactly does a patient take GLP-1?

Courtney Neal, APRN, FNP-C: These are shots. They come in two different forms. If you get it from the manufacturers, if they're prescribed drugs, then they come in a self-injection pen. You get four of them. It goes right into the belly, about an inch outside of the belly button. It's just a push button, super quick, fully contained inside that administration unit, you throw it away and go on with your day. If it's compounded, it comes in vial form. And the patients are responsible for pulling those up or drawing them up into an insulin needle, and then they would administer it the same way in the belly.

Host: And how often?

Courtney Neal, APRN, FNP-C: Once a week

Host: Gotcha. So, how does a patient know which of those GLP-1s is best for them?

Courtney Neal, APRN, FNP-C: Well, they have to talk to a provider, because they have to get it prescribed. And it depends on what they're using it for. So, these medications were created for controlling A1c for type 2 diabetics. So, it boosts insulin production. So when glucose is too high, that insulin will drive the glucose into the cells to use it as energy. So, it really was initially tailored for type 2 diabetics.

The added benefit was the weight loss, which also helps people come out of type 2 diabetes. So, the A1c control really was what we were aiming for here, but the longer that they've been on the market, the more they've been used, the more we're finding out that they have additional uses like weight management.

So, talking to a provider would be best. There are requirements. Type 2 diabetic, absolutely a great candidate. Anyone that has A BMI of 30 or higher for weight management or 27 or higher with cardiac markers, hypertension, hyperlipidemia, or high cholesterol, high blood pressure are also candidates.

So, they really would need to talk to their provider, because there are certain medications that are approved by the FDA for weight loss specifically, and some that are not. So, they would have to talk to a provider about which one's best for them.

Host: Speaking of which, Courtney, when we talk about symptoms that might indicate someone would benefit from this for weight management, is it just a matter of those basic numbers that you mentioned or there are other signs in terms of what you're feeling on a daily basis that this might be for you.

Courtney Neal, APRN, FNP-C: Well, in order to get it prescribed through one of the manufacturers, they have to meet this criteria a hundred percent, or they will get denied by their insurance immediately. There are some people out there that are using the compounded versions of this because they can't get it covered by their insurance or it's not on their drug formulary. So, that's another option for them. And there are some people that want to use it to drop 15 pounds so they can squeeze into an amazing dress for their sister's wedding. It just depends on what they're using it for.

Host: So for diabetics, just how beneficial is GLP-1?

Courtney Neal, APRN, FNP-C: Since we saw Ozempic start to be really successful with diabetics, this is really important, because it regulates their hunger cues and it helps to decrease cravings for sugar. There's something in these medications that changes the palate. So when you start taking them and you're taking them regularly, the palate changes and things that you used to crave are way too sweet. That's one of the reasons that they're starting to actually investigate the science behind these and the possibility of using them for addiction.

Because I have so many patients on these medications and they've come to me and told me that, they were drinking wine two, three nights a week, and now they can't even stand the taste of one sip. So, there are other benefits that are coming to light. But sugar cravings, food noise is what a lot of people call it, it quiets the food noise so that we can really control that blood sugar throughout the day and lower their A1c.

Host: So, Courtney, any risks or side effects associated with these drugs that patients should be aware of?

Courtney Neal, APRN, FNP-C: Well, like any other medication that's prescribed, there are of course side effects or potential side effects. Some of the most common side effects with these medications that we hear about are nausea and vomiting. Certainly, the people that are most sensitive to medications are the ones that we see that actually vomit from these. Diarrhea, constipation, headache, and fatigue, we typically will see these with the lower doses when they're starting to introduce GLP-1 medications into their body. And that tends to slow down or go away a little bit as they increase in their dosage over time. And we typically see these symptoms on days two and three after they initially take their shot.

Host: Any common misconceptions from your experience on a daily basis about using these drugs for weight loss? What are some of the myths maybe that you can correct for us right here?

Courtney Neal, APRN, FNP-C: Well, I think one of the major myths that I hear quite regularly, almost every person that I talk to about this, says, "Well, if I start this now, don't I have to be on it for the rest of my life?" And the answer to that is maybe. It depends on what you do with it while you have it. So, the misconception that you're going to start taking this shot and, all of a sudden, you're going to drop 20 pounds in three days is not accurate, that's not true.

Everybody responds to these medications differently, just like every other medicine out there. It is, one, an individual approach. It's how you use it. I talked earlier about the food noise. These quiet the food noise. A lot of people have that, that nagging noise at eight o'clock at night when you are finally done with your day and you sit down to watch a little bit of TV and that voice in your head that tells you you need popcorn and all the chocolate in the world, it quiets all of that down. But if you don't change your relationship with food while you are on these medications, you're going to go right back to your old habits. You might not gain it all back, you might not gain it all back in a day, but it's going to come back if you don't change your relationship with food.

Host: So speaking of that, talk to us a little bit please about the importance of still taking control of your diet and your exercise and your activity, your lifestyle, and your overall health so that you're not under the wrong impression that this is going to be a be-all end-all by taking GLP-1.

Courtney Neal, APRN, FNP-C: Right. I mean, these are miracle medications. People call them miracle drugs all the time. And they really are. They do a lot of good for a lot of people. But just like any other disease or chronic condition, the way that you eat, your eating habits, and your exercise habits matter, they matter with everything that we do on a daily basis. If you don't take care of your body, it's not going to take care of you, right?

So when we're on these medications, take advantage of the time that you have with the reduced food noise to start really diving in and cleaning up your daily eating habits. And I don't ask people to have a 100% perfect pristine diet. I don't even have that. But 80/20 is kind of the rule that I go with with my patients. Eighty percent of the time, you eat very clean the way that the body was designed to eat. And the other 20% you can indulge a little bit, everything in moderation, including moderation. You can't have a cheat day every day. You can't have a cheat meal, every meal. And we really shouldn't have those anyways because they're very restrictive. They tell us that all the other days of the week I can't have these things. And that's just not the case. You can do anything you want. You can have anything you want. You just have to do it properly and maintain a very clean diet the rest of the time, and move your body.

I talk to my patients about this when we start working on, when I'm counseling them on changing their food habits. We talk about movement and how incredibly important movement is for your body and for your joints and maintaining joint health. And I tell them all the time, starting is the hardest part. I get it. We have all these great ideas and all of these plans. And tomorrow, we're going to get up and we're going to put on our shoes and we're going to go for a run. Well, if you haven't walked around the block in the last 20 years, you're certainly not going to go for a five-mile run.

So, let's be realistic about this. And I tell them 15 minutes outside, get your body moving. If you're not feeling it after those 15 minutes, go and claim your spot on the couch, but earn it. Earn your spot on the couch every single day. And they'll work up to an hour. They'll work up to, you know, 45 minutes, whatever. Start with 15 minutes. It takes 15 minutes for those feel-good endorphins to kick in when you're working out. If after 15 minutes you're not feeling it, walk home and try again tomorrow.

Host: Great advice indeed for anyone, I think. So in summary here, Courtney, for those that are hesitant about getting started with a GLP-1 treatment, we know how many people are doing this. But for those that are still like, "Hmm, an injection? I don't know," what would you say to people that are hesitant about getting started?

Courtney Neal, APRN, FNP-C: Talk to their provider. There are different options. These injectable pens, you're pushing a button. You're not giving yourself the injection when you're doing it that way. So, it's a little bit easier for some people to take. But talk to your provider. Talk to them about your concerns. Talk to them about your hesitations. Talk to them about your fears. You know, you don't have to do anything that we tell you to do. It's your body, your choice, always. And I tell my patients that every single day.

I have hundreds of patients on these medications. I've seen their success. I counsel them and I guide them almost on a daily basis. You have the support that you need, so talk to a provider and express your fears. Tell them your hesitations. Talk to them about it. Let us either reduce those and tell you what it's really going to be like, or tell you, "Then, maybe it's not the drug for you," and we'll figure something else out.

Host: Well, folks, we trust you are now more familiar with GLP-1. Courtney says you have to earn your spot on the couch. Courtney, when I flop onto the couch later on tonight, I'm going to ask myself that very question. "Have you earned this?" Have you earned it, right? Courtney, thanks so much again, as always.

Courtney Neal, APRN, FNP-C: Always pleasure Joey.

Host: Same here. And for more information, please visit wickhosp, W-I-C-K-H-O-S-P.com/wickcaretalks. We hope today's discussion has provided you with valuable insights to support your wellbeing. Remember, every step you take is a step toward a healthier life. To ensure you don't miss future episodes, please follow us on your favorite podcast platform. If you found this episode helpful, please do share it on your social media. And thanks again for being part of WickCare Talks. Until next time, stay well.