Episode 254: Ask the Obesity Doctor Part 1: GLP-1, Contrave, Thyroid, Dosing & Calories

[00:00:00] Welcome back to the Back on Track Achieving Healthy Weight Loss, where I help you get on track and stay on track with your weight loss journey. I'm your host, Dr. Alicia Shelly. So let's get started.

[00:00:28] Welcome back to the Back on Track Achieving Healthy Weight Loss podcast. I'm your host, Dr. Alicia Shelly. Now today we're going to be doing something a little different, and I think this is going to be a little bit of a fun one. If you watch my videos or follow me on social media, you know that I get lots of questions about weight loss medications. So I went through some of the actual questions you've asked me, and today I'm answering at least five of them. And what I want to emphasize is that these are real questions from real people who have watched my videos.

[00:00:58] And the other thing I want to mention is that this podcast, this video, is for education only. So because I don't know your medical conditions, it's important that you see your actual doctor who knows you and ask some of these questions as well. Because I don't want to give you necessarily medical advice because it may not pertain to you. Like, you know, it may not pertain to you in your story, but I do want to answer broadly.

[00:01:25] I plan to at least answer the more common questions that I see. So let's get started. Question number one, can you take Contrave with a GLP-1? This question came from CocoPuff01 on my video all about Contrave. And so can you take Contrave with GOP-1? Now, sometimes the question would be what will having both of them actually help?

[00:01:50] So usually what I'll do with a patient, because GLP-1s are a little bit more efficient in weight loss, I may start there. But I've had a few patients where they have noticed still having a lot more hunger, even at the max dose of the GLP-1. And so in that case, I will say, hey, let's try Contrave. Contrave has been known to help with food noise. And for some people that added benefit can it can help.

[00:02:17] And so as long as you meet the criteria and there's not a contradiction, I have given patients Contrave plus a GOP-1 and it has helped. Now, I will admit there's no guidelines recommending this, but sometimes that combination can work. And because they do work in different avenues, that may be another option for you, especially if you're still having a lot more hunger noise and cravings.

[00:02:42] But once again, make sure you talk with your doctor in regards to your own personal history. Now, if you're not familiar with what Contrave is, it is actually a combination of naltrexone and bupropion. Naltrexone is a medication we use for many different reasons, but the most common one that we use it for is to help individuals with the craving of alcohol. It helps to reduce that craving.

[00:03:05] Also, bupropion we use for depression, anxiety, but it's also been used for smoking cessation. And it can help with food noise as well, especially when combined together. So, you know, the one thing you do need to make a mention, especially with Contrave, it is contraindicated individuals who are taking, we have a history of seizures because it can lower that threshold and make it easier for those seizures to come up.

[00:03:32] And then if you're taking an opiate medication, so naltrexone works by blocking that opiate receptor. And so if you're already on taking like a pain pill, such as Percocet or morphine or something like that, then the naltrexone, you wouldn't want to be on contra because it'll stop those medications from working well. But if you don't have that contraindication, you're doing well and you're having still some food noise, then definitely you want to talk to a doctor about that option for you.

[00:04:02] So, all right. Question number two. Can you take a GOP-1 if you have hypothyroidism or Hashimoto's? Now, for those who are not familiar, Hashimoto's is the name of the autoimmune disorder that affects the thyroid. So basically your body is attacking the thyroid and it's causing the thyroid levels to start to go down.

[00:04:28] So a lot of people will become, will be a low thyroid where they're not producing enough and they tend to have symptoms of tiredness, fatigue, they have weight gain. It's hard to kind of tolerate cold environments. Those would be the signs if you're having low thyroid or Hashimoto's disease and you should be checked out by your doctor. They, there's blood work that they can do to evaluate that, to see if you have Hashimoto's or see if your thyroid is low.

[00:04:57] But the question is, can you take a GOP-1 if you have these conditions? And this actually came from one of my new YouTube videos, the new FDA approved weight loss medication fundale. I'm going to say this name wrong, but Ahmed Mun, our A-H-M-D-M-U-N, asked whether somebody who with hypothyroidism can take fundale. One of the new GOP ones that are out. Also at Battlecore 501 asked, my wife wants to try Zep bound, but she has Hashimoto's.

[00:05:27] Any information known as far as side effects with a bad thyroid? So the answer to that is, there is no, you know, there's not a contraindication with those individuals. I'm taking a GOP-1 plus hypothyroidism or Hashimoto's. So they can take it together. It's not a problem. I have patients who have both and we do start them on the medication to help with kind of suppressing that appetite. Because sometimes, especially as the doctors are trying to level out your thyroid, there can be some weight gain.

[00:05:55] And so the GOP ones can really help balance that out until they get the right medication for you. The one reason, and I just want to speak a little bit about GOP ones and thyroid disease. There is a black box warning on all GLP-1s. And that was for the risk of thyroid C cell tumors. Now that risk was seen when they were doing research in rats. So rats tend to develop thyroid C cell tumors and those rats being given GOP ones.

[00:06:24] However, they have not seen an increase of thyroid C cell tumors in humans. But they just recommend if you have a contraindication to, if a family member or you personally have medullary thyroid cancer or MEN2, multiple endocrine neoplasia type 2, then they recommend not to be on this medication because we don't know how it's going to react or whether this may put you at more risk for thyroid cancer.

[00:06:51] Because you already are at risk due to that family history or personal history already. But like I mentioned, they haven't noticed it as far as the thyroid C cell tumors increase in humans. Now, the other question I get from patients is, well, if I have a nodule on my throat, you know, does that put me at risk? You know, does these GOP ones increase my risk of nodules? It does not increase the risk of nodules.

[00:07:17] Some of us have thyroid nodules we just are not aware of because it's not big enough. We don't feel it. It's not necessarily impacting us. But for those individuals who are concerned about their thyroid and GOP ones, definitely is important to see your own doctor. You know, they may want to do an ultrasound just to baseline just to see where you're starting. And so needless to say, the one thing I will also say about fundale specifically is that it is not pharmacologically active in rats.

[00:07:44] So it did not cause any thyroid C cell tumors. But since it is part of that GOP one family, they still have that black box warning. So just so you know, hypothyroidism and Hashimoto's disease are not the same as thyroid medullary thyroid cancer. And currently that medullary thyroid cancer and ME in two are the two contraindications to taking GOP ones in general. And this the that is a class effect, meaning that all GOP ones have this black box warning.

[00:08:13] So what type of thyroid disease they have actually matters. And it's OK for you to take it if you do not have those two that I mentioned. All right. Question number three. Can I increase my dose faster if I'm not having any side effects? So our third question comes from Addie Thompson, 8098. My video will go these highest dose explain. Is it safe and effective?

[00:08:37] And the question was, could I double up to the 4.8 milligrams before the 7.2 milligrams? Now, for those who are familiar with Wagovi, Wagovi, the highest dose was 2.4 for a long time. But just recently they've increased it to the next dose up or Wagovi HD, which is 7.2 milligrams. And I've had a lot of patients when I told them about the 7.2 be very concerned. They're like, wait a minute. Why is it such a big jump?

[00:09:06] Because Wagovi starts off at 0.25, then 0.5, then 1 and then 1.7 and then 2.4. And then now 7.2. And so it's understandable why some patients may be a little nervous about that 7.2 and want to try doubling the 2.4 to taking 4.8 instead of going to the 7.2.

[00:09:27] And I do want to just reassure you that, you know, Wagovi, the Novo Nordisk company has done its fair diligence with research and they found it safe to take the 7.2 milligrams. Now, of course, you should always speak to your doctor about what's, you know, because they know you on what's the next dose. But I've had patients go from 2.4 to 7.2 and they did well, especially if they were on 2.4 for a long time. They weren't having any side effects.

[00:09:56] Then that was, you know, the 7.2, they liked it because it helped to give them a little bit more suppression. The average weight loss that we see was 7.2 is approximately 20 percent. It's getting up there in combination to where the Zepbound, which is average weight loss was 20 percent as well. So know that they've done their due diligence. Going up to 7.2 should not put you at any more risk for side effects, especially if you were tolerating it fine for several months up to that point.

[00:10:25] And so the other question is, when should I increase my dose or should I increase my dose faster if I'm not having side effects? So I'm of the belief and of the camp that you should start at the lowest dose and taper up slowly. That reason being is that when, you know, Wagovi came out, we found a lot of people getting sick. Not just with Wagovi, but just the GOP ones for weight loss were getting sick because we were just kind of titrating up too fast.

[00:10:55] And so I found that by listening to my patients' bodies and how they're responding, that is a better way of knowing when to increase. So I like to look at my patient and I like to make sure I ask them, is the medication curbing your appetite? And are you having side effects? You know, because if you're having side effects, then we need to stay at that same dose or go lower just to allow your body to get used to it before we go up. Because a lot of the GI side effects, it can be temporary for some people.

[00:11:25] Everyone's different. But for some people, it can improve as your body gets used to the medication. So if you're having a lot of side effects, it may be better to go down for a few months, let your body get used to it and then try to taper up slowly. So for my patients, I like to ask them, you notice that the appetite is actually starting to come back before you get to your next shot? And that's another sign that we need to go up on it. So I always like to give that to them. And then when they let me know, we can be able to taper up.

[00:11:54] But I like to start low and taper up slowly just so that, first of all, you're getting the maximum benefit for each dose. But then secondly, you're not having side effects. So that's what's very important. But I would not accelerate the schedule. I wouldn't say every two weeks you go up because you're going to be at more risk for side effects. So start low. They say you got to be on dose for one month before we go up. That's the fastest we're going to go.

[00:12:22] So with that being said, let's move on to question number four, which is, can I change the day I take my GOP-1? So this question comes from at Lovely Stormy on my video, how to restart a GOP-1 medication. They were asking about changing the injection days. For example, moving an injection from Thursday to Sunday. Very practical question. This happens all the time. So usually what you can do is, let's say if you wanted to move it to that Sunday, you just kind of would hold it.

[00:12:51] So if you normally take it Thursday, you'll just hold it to Sunday and you should be fine. You know, as I find for patients as long as even if you like miss a week, like you go on vacation, you miss it and you come back and take it, you're still pretty fine. If you are one that experienced a lot, very sensitive and experienced a lot of side effects, then by you holding off for just a few days, just four days until Sunday, you should be fine to restart the medication. It should not be an issue.

[00:13:20] So let's say you miss a dose, like you normally on Thursday, but you miss it. And then you remember it like two days later, you can still take the injection as long as it's not four days before you have your next injection. So what I mean is, so if it's on that Thursday and you remember it on Saturday, since you have more than four days until your next Thursday injection, you can go ahead and take it that Saturday.

[00:13:46] But if you take it on Thursday, but you remember it on Tuesday, then you just need to keep hold it until Thursday because you have two days before that Thursday because you don't want to take it within four days of each other. So depending on when you remember it, please definitely take it and know that it's OK to change days. You know, if you miss a week the next day, usually people are fine. The medication usually stays into your system for a good, you know, two months or so.

[00:14:15] So, you know, you should be fine. But definitely speak to your doctor if there's any questions about moving injections or anything, because they may have other advice for you. All right. Last question. How many calories should I actually be eating? Hey, this question comes from at John Brabra, 8603 on my video. This diet mistake is slowing your metabolism. And he asked, what's the best way to know how many calories to eat or if you're getting enough?

[00:14:44] And so that's actually a great question because a lot of people actually under eat. They're not eating enough. They are just like, I'm not hungry. So I'm just not going to eat. They'll go from eating three meals to one meal thinking, hey, I'm eating one meal. I've cut back. I should be losing weight. But what happens is their body actually goes into starvation mode. So they're not losing weight. They're just kind of staying the same. And so it's important that our body actually has fuel.

[00:15:10] It's important that we're making sure we're getting a balanced meal with protein, veggies, and even a little starch. Because your body does need that for hormone production and things of that nature. So it's important that we're getting that balance. And so it is important to ask, well, how much should I be eating?

[00:15:27] So I do want to just point you to the NIH has a body weight where it can kind of share with you how much calories you should be eating based on your body, your height, your weight, your activity level, what you plan to change and how that would change the calories. So it goes through all of it.

[00:16:15] And you see them. So because there's multiple different factors when it comes to calories, your age, your sex, weight, body composition, things of that nature. So in conclusion, thank you to all my viewers who actually asked those five questions. I hope I was able to answer them. And know that we are not finished. We have a part two of Ask the Obesity Doctor.

[00:16:37] But we'll talk a little bit more about Olympic phase, fake and black market peptides, medication interactions, and side effects. So thank you so much for your time today. And if you have a question, I'd like to answer it and if you need to answer it in a future episode, please feel free to leave it for me on social media. I'll be happy to answer that question for you. Thank you for listening. And don't forget to share with someone who needs to hear this.

[00:17:04] And always remember, until next time, stay strong, stay committed and stay consistent because we are stronger together. See you next time.