Dr. Paul Kolodzik - The Continuous Glucose Monitor (CGM) Expert
Telemedicine services available in OH, IN, FL, AZ
GLP-1 Medication Program Philosophy
GLP-1 Medications can be effective at both helping our patients get a jumpstart on weight loss and improved health, and working through a possible plateau in a weight loss journey. However, these medications are not without potential downsides. Downsides include:
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Medication side effects
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Muscle mass loss while taking the medication
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Weight being regained when the medication is stopped.
Dr. Paul believes that for most patients, GLP-1 medication use should be for limited periods of time, and, when possible, at a lower effective dosage. His goal for his patients is to have them meet their weight loss and health goals, and avoid ongoing dependency on medication to maintain weight loss and good health.
In other words, as he tells his patients, “Begin With The End In Mind.” The end being maintaining a lower weight and improved health well after the medication is stopped.
This goal is achieved by nearly all our patients because other program components have been implemented during medication treatment, and become habits that are sustained for a
lifetime:
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Low Carb Diet
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Intermittent Fasting
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Exercise Regimen with Emphasis on Strength Training
If you are interested in integrating GLP-1 medication in your treatment plan, let Dr. Paul know this at the time of your complementary consultation.
What is GLP-1 ?
How Semaglutide Works.
GLP-1 medications have received much attention recently for their effectiveness for weight loss. The active ingredient in these medications is semaglutide. This is the most prescribed GLP-1 medication. Brand name GLP-1 medications have been FDA-approved and were originally prescribed to diabetics for the purpose of controlling blood glucose. They subsequently were approved for weight loss. Compounded GLP-1 medications are not approved by the FDA, and even are not considered generics, but are created in state-licensed pharmacies. Al these medications are once-weekly injectable medications. When treatment is initiated, they are started as a low dose, and the dose is gradually increased until a therapeutically effective dose is reached. They mimic the body’s natural GLP-1 gastrointestinal hormones to help control blood glucose and hunger to achieve weight loss.
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In the initial studies on diabetics this medication was found to be very effective at lowering blood sugar with the added benefit of achieving weight loss. After seeing the weight loss this medicine achieved in patients with Type II diabetes, the brand name medicines were marketed for weight loss in nondiabetic individuals.
For diabetics, brand name Semaglutide is often covered by insurance. Out of pocket costs for diabetics are often low. For patients who are not diabetic, however, we have found insurance coverage for brand name medications can be very limited, and out of pocket costs can be high.
The compounded version of semaglutide is not a brand name medication and is not FDA approved (but is manufactured in state licensed pharmacies). It can be prescribed by medical providers for weight loss. In fact, the compounded version is now widely prescribed in the US for this purpose, with out-of-pocket costs being lower. Metabolic MD prescribes the compounded version of this medication and our experience is that it has been effective for nearly all our patients in achieving weight loss and we have not seen any increased incidence in our patients of side effects or other complications
When & How Should These Medications be Prescribed for Weight Loss?
Metabolic MD prescribes brand name medications to patients whenever possible. We also prescribe compounded semaglutide (again, which is not FDA approved). Our regimens generally use lower doses and only as part of a comprehensive weight loss and metabolic health program. We use these medications in two instances:
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For a patient who wants to get a “jump start” on their weight loss program, but only with the understanding that other lifestyle changes be implemented simultaneously (low carb diet, intermittent fasting, exercise routine emphasizing strength training)
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Temporarily (usually a period of months) for a patient who stalls or plateaus during their weight loss effort, despite participation in a comprehensive program (as outlined above).
One of the goals when using these mediations, optimally, is that their use be temporary. We do not believe they should be prescribed to patients in a manner that commits them to lifetime dependence. This is why we only use them as part of a comprehensive program as outlined above. Therefore, we use limited (not maximum) dosing so we can eventually titrate our patients off the medication without significant weight regain. Weight regains upon medication discontinuation is very common (often up to 60% of the weight lost), and can only be avoided with the institution of diet and exercise lifestyle changes while under treatment.
How does Semaglutide work?
GLP-1s are effective for several reasons. First, a GLP-1 acts on the hypothalamus in the brain, which regulates our sensation of hunger. With this action on the hypothalamus the drug alters the food-reward system and prolongs our sense of fullness (satiety). GLP-1 drugs also slow down the motility of the gastrointestinal tract. Put more simply, it keeps food in your stomach for longer than usual, keeping you full longer. Finally, the drugs lower blood glucose. When blood glucose is lowered, fatty acids are used by the body as an energy source. When fat is burned, weight is lost.
How Much Weight Can I Lose?
We believe a comprehensive program utilizing the following components best achieves optimal weight loss and health improvement:
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A focused low carb diet (best guided by the use of a continuous glucose monitor)
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Intermittent fasting
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An exercise regimen with a focus on strength training.
Weight loss of 15 to 20% of body weight is not uncommon.
With a GLP-1 you can help you lose weight, but that weight loss is likely not to be permanent after medication discontinuation, without lifestyle changes. Weight re-gain after stopping the medication is common, unless diet and exercise lifestyle changes have been ingrained. In our practice, we help our patients address the root causes of weight gain with a comprehensive program. We look to help our patients implement healthy lifestyle changes that will last a lifetime, and prevent weight regain when the medication is discontinued.
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How Fast Does Semaglutide Work?
The short answer is that many of our patients begin to lose weight in the first month. The first dose is small, but then the dose is titrated up over the following weeks. These lower doses are primarily used to gently introduce the medication to the body without risking developing significant side effects (mostly nausea).
All studies done on weight loss with this medication have shown effectiveness only when it is used in combination with an effective diet and exercise plan. At Metabolic MD, we believe the most effective dietary approach is a low carb diet, and the best exercise plan includes strength training. Our GLP-1 prescribing always is accompanied by detailed guidance related to your diet and an appropriate associated exercise regimen. We have proven that an extremely effective approach to weight loss is a continuous glucose monitor guided low carb diet in conjunction with a GLP-1.
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Who is Eligible for Weight Loss Treatment with Semaglutide?
Brand name GLP-1’s may be covered by private insurance for those diagnosed with type 2 diabetes. Less often there is insurance coverage for obesity. Compounded GLP-1 medications are not covered by insurance because they are not FDA approved. However, the out-of-pocket costs for these medications are less.
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Does Semaglutide have Side Effects?
Some people can have mild to moderate side effects, however most of these are manageable by proper dosing. Significant side effects may occur, but in our experience are rare.
The most common side effects are: nausea, diarrhea, vomiting, constipation, and mild stomach pain. We see some mild nausea in many patients, however based on our low dosing regimens, we have found that other side effects are very rare. Other more serious side effects may also occur, but again, in our experience are rare.
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In our experience, most side effects can be limited with prudent/lower dosing.
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How Fast Can You Increase the Dose?
GLP-1s are taken as a once weekly injection “escalating” dose. This means you start the medication at a low dose, and increase the dosage gradually over a period of months. Progression on this regimen assumes side-effects are minimal. We have not had any patients need to discontinue treatment due to side effects. Part of the reason for his is that we keep the doses on the lower side.
We weigh several factors when deciding how and when to increase the dose for our patients. The first is whether you experienced significant side effects during your week of treatment during initiation or as the dose is increased. How fast dosing is increased for our patients is individualized and tailored to the needs of each patient. The individualized approach allows us to maximize the benefits of the medication while keeping side effects to a minimum.
Metabolic MD also has a philosophy of utilizing the lowest dose necessary to achieve effective weight loss. This is for two reasons. Avoiding high doses helps to avoid wight regain when patients are titrated back down and off the medication. Also, higher doses of medication can result in significant muscle loss. Lower dosing (in conjunction with the strength training guidance we provide) helps avoid muscle loss. This is especially important for older patients and in women at risk for osteoporosis.
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How Do You Administer Semaglutide?
​This medication is a taken as a once-weekly subcutaneous injection. The FDA approved brand name medications are injected using an injection pen. This injection is self-administered at home. Compounded medications (not FDA approved, not considered generics, but made in stat licensed pharmacies) are injected with a VERY SMALL (31 gauge) needle into the abdominal area. If compounded semaglutide is provided, it must be drawn up into an insulin syringe from a vial. It is then injected in a manner similar to an insulin injection. The injection cannot be said to be 100% painless, but causes very minimal discomfort for most patients. If the compounded medication is utilized, we walk all our patients through the injection process either in office or by telemedicine.
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Who Should Not Use Semaglutide?
There are some situations in which a GLP-1 is “contraindicated,” meaning an individual with a specific condition should not use this medicine. The major contraindications to treatment are:
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patients with a personal or family history of medullary thyroid carcinoma
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patients with a personal or family history of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
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diabetic retinopathy, a type of damage to the eye from diabetes
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a history of recurrent low blood sugar
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recurrent disease of the gallbladder (patients who have had their gallbladder removed are not included in this group)
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decreased kidney function
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pancreatitis
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Inflammatory bowel disease
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patients on any medications that lower blood sugar
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patients on the blood thinner coumadin (also called warfarin)
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I Have Heard Semaglutide Is in Short Supply, and Medication Availability is subject to “Supply Chain” Issues.
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Due to the demand for Semaglutide at times these medications have been in short supply. Metabolic MD has not had issues suppling compounded semaglutide to appropriate patients.
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Metabolic MD Pharmacies Network If
A Compounded GLP-1 is Prescribed:
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To see the licensed compounded pharmacies Metabolic MD utilizes to obtain medications for our patients click here:
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​These are state licensed pharmacies. But again, remember that although widely prescribed, compounded medications are not FDA approved and not considered a generic.
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How Can I Learn More?
If you have an interest in being prescribed a GLP-1 as part of a comprehensive weight loss and metabolic health program please contact Metabolic MD for a free complementary phone consultation with Doctor Paul. You can schedule your consultation at this link: complimentary phone consultation.
You must reside in the states of OH, IN, FL or AZ to receive a no cost consultation.
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Please click on the above link and complete our short patient inquiry form, and a member of the Metabolic MD team will be in touch with you to arrange your no cost phone consultation. This form is also on our website under the Contacts Tab.
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​Why Use Metabolic MD For Your GLP-1 Medication Program?
​Please Dr. Paul and his team have had years of experience helping patients effectively use these medications as part of a comprehensive program. We provide complete program guidance with a diet and exercise plan to help you use the medications effectively, lose weight and improve health, and then be able to get off the medication. Our goal for you is weight loss and health improvement – resetting your health and your weight - with temporary medication use. You then will sustain your improved health at your lower weight for a lifetime with the healthy habits we have helped you make permanent.
