One in eight American adults (almost 6% of all American adults, about 15 million people) has tried a GLP-1. I can see why. You inject yourself once a week. You lose weight. Your life gets easier. What they do, mechanistically, is mimic an incretin hormone (GLP-1) that your gut releases when you eat. This suppresses appetite, slows gastric emptying, and increases insulin response. You lose weight because you don’t feel like eating. But nothing in life is that simple. When people lose weight on a GLP-1, roughly 25-40% of what they lose isn't fat… It's lean mass. Muscle, bone, and organ tissue. The STEP 1 trial of semaglutide (the trial that led to the drug's approval for weight loss) showed that lean mass accounted for about 45% of total weight loss. SURMOUNT-1 with tirzepatide put it closer to 25-35%. Liraglutide (the earlier-generation GLP-1) ran as high as 60% in some studies. Some GLP-1 defenders say that every weight-loss method causes some lean tissue loss. Diet, exercise, bariatric surgery, all of them. True. But there are two things wrong with that defense. First, GLP-1s cause a higher proportion of lean tissue lost than most other methods, especially when users don’t do resistance training or eat enough protein (most aren't since the drugs suppress appetite). Second (and this is the thing nobody's talking about), losing that much lean tissue while trying to fix metabolic dysfunction accelerates the underlying problem. Here's why… Muscle is the most metabolically active tissue in your body. It burns calories at rest and absorbs glucose. It's where insulin sensitivity lives. Lose 5-7 kg of lean mass (what semaglutide users averaged in STEP 1), and your resting metabolic rate drops. This hampers your ability to burn glucose. Insulin sensitivity worsens. Less muscle also means less exercise capacity. You lift less, walk less, and push less in the gym, burning fewer calories with exercise and stagnating in your fitness goals. And then there’s bone loss.

Vitamin E is the collective name for a group of fat soluble nutrients that function as antioxidants to protect cells and tissues. Antioxidants protect cells from free radical damage. Sounds like a sci-fi movie but actually free radicals are all around us (and we even create some ourselves). Free radicals are unstable molecules that damage cells, some well known examples we’ve likely all had exposure to include: - UV rays - Exercise - Cigarette smoke - Environmental pollution - Standard American Diet (SAD) - Alcohol #1 Helps reduce oxidative stress Antioxidants are substances that protect cells from the damaging effects of free radicals, in our environment or produced endogenously. Free radicals are unstable molecules that contain an unshared electron. Free radicals damage cells and might contribute to the development of cardiovascular disease and cancer. Sources of free radicals include those produced internally through physiologic stress like exercise and also environmental exposures including cigarette smoke (first and second hand), UV rays from the sun and pollution. Vitamin E is a free radical scavenger, essentially diffusing the dangerous capabilities of free radicals and protecting cells in the process. Because free radicals have the capability to damage cell membranes, proteins and nucleic acids, they can contribute to cancer risk. Take for example free radicals from UV rays causing skin cancer. Antioxidants including vitamin e, vitamin c and selenium may therefore play a role in cancer prevention and other chronic illness associated with free radical damage. #2 Boosts Immune Function Not only does vitamin E protect cells against damage but it also helps regulate immune function. Vitamin E is involved in regulation of gene expression and cell signalling. Because of its role in immune function, it is found in higher concentrations in immune cells compare to other cells. In fact, research shows it is one of the most effective nutrients that keeps the immune system running smoothly.

Mild cognitive impairment is a condition characterized by a noticeable decline in cognitive abilities that exceeds normal age-related changes but doesn't significantly interfere with daily life. As Dr. Thanos Chatzikostopoulos and colleagues note in their study, "MCI can be defined as an objective impairment in one or more cognitive functions projected on standardized neuropsychological tests, while maintaining the ability to complete daily activities." Key features of MCI include: - Memory problems, especially in amnestic MCI - Difficulties with executive functions like planning and decision-making - Potential progression to Alzheimer's disease or other forms of dementia Pomegranate seed oil (PSO), derived from the seeds of the Punica granatum fruit, has long been valued for its potential health benefits. Rich in punicic acid and other bioactive compounds, PSO has shown promise in various areas of health. But could it really make a difference in cognitive function? The results of the study were remarkably positive for pomegranate seed oil: "The results showed that the participants who took the PSO had statistically significantly better global cognition (p = 0.004), verbal episodic memory (p = 0.009), and processing and executive functions (p < 0.001) in contrast with the participants who did not take it." In layman's terms, the group taking pomegranate seed oil showed significant improvements in overall thinking skills, memory for words and events, and the ability to process information and make decisions. The control group, by contrast, showed no significant improvements and even some decline in certain areas. While the exact mechanisms of PSO's cognitive benefits are still being explored, several theories have been proposed: 1. Antioxidant effects: PSO's high content of punicic acid and other compounds may help combat oxidative stress in the brain. 2. Anti-inflammatory action: Reduced inflammation could protect brain cells from damage. 3. Neuroprotective properties: Certain components of PSO may directly support brain cell health and function.

I’ve seen A LOT of discussion on peptides recently. This is a broad topic with lots of different classes of peptides. There are lots of nuances involved in this new modality but I'll share a few thoughts. I want to preface this by saying that we DO peptide therapy at the office. However, we we do it proper care, follow up and caution. We go case by case and determine if you need it or not. There are a lot of people talking about the benefits of peptides and these molecules are being hailed as a fountain of youth. While I do appreciate the unique benefits that peptides can have, I’m also concerned about side effects that I do not see being discussed and long term issues that we do not fully understand at this point. - Peptides are synthetic signaling molecules -- most require injection because your gut destroys them (however, we use liposomal, sublingual peptides that bypass the gut and do not require injection). - For people trapped in severe obesity or metabolic dysfunction, GLP-1s can be a genuine lifeline -- breaking a cycle that diet alone couldn’t crack and reducing cardiovascular risk. - The science of incretin signaling, driven by GLP-1s, has taught us more about satiety than anything in the last 50 years - Some peptides like BPC-157 show real promise for acute injury recovery in animal models -- but the human evidence is almost nonexistent - The trade-offs are real: up to 40% of weight lost on GLP-1s may be muscle, stopping means rapid regain, and the drug class is escalating -- from single to dual to triple receptor agonists -- each more potent, each less understood long-term - BPC-157 and TB-500 ("the Wolverine stack") promote blood vessel growth through the same pathway active in half of all human cancers. Almost zero human data - Growth hormone secretagogues can worsen insulin resistance and elevate cancer-linked IGF-1 - Melanotan crosses the blood-brain barrier and has been linked to melanoma in case reports - The biggest concern: these drugs treat the symptom without addressing the root cause -- and none of them replace what food, sunlight, sleep, and movement can do.

The ability to meet the demands of your life with abundant energy, to rest and recover fully, and to be as adaptable as needed to how demands may change over time outside your control, or to how you may choose to willfully change the purpose of your life. It is a state in which the body functions at its optimum without pain or symptoms. This is my definition of health. What is yours?