463 | Navigating Peptides, GLP-1, and Weight Loss during Hormonal Shifts in Perimenopause with Dr Aleksandra Gajer

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen. And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions. Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in. Speaking of weight loss, I've actually been on my own fat loss journey and I've added in the Zulu Weighted Vest.

[00:00:35] And I'm telling you, not only has it motivated me to get my steps in and move a little bit more, but it's also impacted my strength because Dom and I, every week, at least once a week, we take a long walk to a park nearby with our boys. And I've started adding in pull-ups with my 16 added pounds in my Zulu weighted vest. And Dom has actually added his own with a 20 pound Zulu weighted vest.

[00:01:00] And we have been able to improve just our strength and body weight movements that we could do at the park with the boys. It's made a massive impact on how I feel. And not only do I know that it's improved my cardiovascular system and my cardiovascular health, but it's really making a difference in increasing my calorie burn and just getting a little bit more movement in every day. Now, what I love about Zulu specifically is that it has a machine washable fresh layer so I could take it off and wash it and not feel like I'm getting stinky even though I'm getting sweaty.

[00:01:28] It's also adjustable to fit anybody. It has front pockets so I could put my phone in there and it has reflexive detail so I feel safe if I'm walking a little later at night. I cannot say enough good things about this weighted vest. And if you've ever considered adding in a tool that's going to naturally improve your posture as you're walking, give you that core awareness and give you that extra calorie burn, I'd highly recommend checking the link in our show notes and using code OPTIMAL for an additional 20% off at checkout.

[00:01:55] We are so honored to have Dr. Aleksandra Gajer on the podcast today. She's originally from Poland, raised in the United States and is a dedicated medical professional focusing on advancing healthcare. She graduated with top honors at the University of Maryland School of Medicine and completed her residency in academic emergency medicine at George Washington University. Dr. Gajer's special interests include sustainable weight loss, balanced hormone health and longevity.

[00:02:23] She emphasizes the importance of lifestyle adjustments to optimize patients' biology, promoting health, vitality and long-term wellness. Inspired by her experiences in emergency medicine, working with communities facing health challenges, she shifted her focus to proactive, comprehensive healthcare. Establishing the Geyer practice allows her to offer personalized care and empower individuals to lead healthier lives by intervening before illness takes hold.

[00:02:51] Driven by her lifelong goal, she is enthusiastic about sharing her expertise and dedication to contribute to a healthier future for her community. And she really does such a wonderful job. I know you're going to get so much out of this episode. Dr. Geyer, thank you so much for coming and chatting with us today. I know a ton of people in our audience are going to be really interested in your area of expertise because you work with a lot of people in midlife, paramenopause and menopause and all the changes that the body is going through.

[00:03:21] But I just have a question because I know that you initially worked or previously worked in emergency medicine, literally saving lives. And we just watched the season finale of The Pit. So I'm sure it's exactly like The Pit depicts. But what made you make this decision to say, OK, I need to change my area of focus to more so focus on the proactive and preventative side of medicine? Yeah. Well, thank you so much for having me.

[00:03:51] I'm so excited to be with you guys today. And actually, The Pit is pretty medically accurate. So the main source of emergency medicine education is this production called MRAP. And they actually helped produce the show, too. So it's actually pretty as far as medical shows go. It's pretty accurate. But yeah, so I started my career in emergency medicine. I really loved emergency medicine. I love being in ground zero with people and getting to fix all the problems.

[00:04:21] And when you do it for a number of years, you realize that maybe 10% of it is the action, the accidents, the things that are really fixable. And 90% is actually chronic illness. And chronic illnesses that we see, they took hold, took root, maybe 15, 20 years before I see a patient for that emergency visit. And what I found was that I was putting Band-Aids on problems that were continually getting worse. And I was seeing the same people over and over again.

[00:04:50] And at the stage of illness they were at, there's not much that I could do to reverse it, especially in that system. So, you know, very early on I became interested in not just treating disease, but what creates a state of health.

[00:05:06] And, you know, alongside my years in the emergency room, I started doing all these courses and studying something that really was a bigger interest for me is, you know, yes, maybe I can buy this person another year of life by patching them up in the ER. But what can we do to actually create health, a life that's worth living, vitality, you know, health span? And I suffered my own health issues as well as burnout in the ER.

[00:05:32] And eventually I, the stars aligned and I got to leave and start my practice. And yeah, it's been an incredible journey. Taking a quick pause from the interview and being that we're talking about weight loss, I figured it was only fitting to talk about optimizing nutrition. And something that Jen and I have been using for multiple years now is Needed's supplements and multivitamins.

[00:05:55] Now, Needed was vital during our conception, prenatal and postpartum journeys, especially for Jen. But one of the reasons that we love Needed is they really do the testing on the ground level. And they make sure to test thousands of women to make sure that all of their supplements have the absolute optimal amount of each ingredient in them. In their supplements, you also won't find unnecessary fillers, poor nutrient forms, unsustainably sourced ingredients or high heavy metal loads.

[00:06:23] They also make sure that you're taking nutrients together or separately that you should be, such as omega-3 and iron. I mostly focus on taking their daily multivitamin while Jen has been really focusing on her CoQ10, fish oil and iron supplements. And Needed has really grown an incredible, incredible reputation in the space and is trusted by thousands of practitioners who recommend these supplements to their patients. So head over to thisisneeded.com and use code OPTIMAL for 20% off your first order.

[00:06:53] That's T-H-I-S-I-S-N-E-E-D-E-D.com and make sure to use code OPTIMAL for 20% off your first order. All right, let's get back into the interview. That's great. I mean, I can't imagine the level of burnout, especially in that kind of setting. And you're right. You don't get the... Which they talk about in the pit too. So that's also accurate. I mean, it's even accurate just as physical therapy, like for what we do in terms of burnout.

[00:07:20] So I can't even imagine in a much higher intense situation, you know, day to day on what you're dealing with. And it's so... I mean, exactly what you said. You know, you don't have the opportunity, the time to be able to spend with patients, to get them on a deeper level, caring about why they'd want to go deeper to really get to, you know, how could we prevent you from coming back again? You know, it's just so hard.

[00:07:48] I remember one ER visit where I was having so many stomach issues and one ER doc took the time to really sit down and ask me questions and ask me like mental health stuff. And like, that was like unheard of. And I know that his shift was over. He was supposed to go home. And it's like, but no one has the time to do that, you know, and actually get to know a person.

[00:08:12] So I think what you have been able to provide and do now is going to be so helpful. And hopefully we'll get a little glimpse of what that is so that people can like take home some really good like understanding of what they could do right now and today. Because so many, especially women, as we go through so many changes in our life, you know, we'll go to our general practitioner.

[00:08:37] We'll get our blood work done and panels run and be told it's normal. And, you know, nothing is out of the ordinary, not sure why you're feeling this way. Maybe just work on stress reduction or, you know, where it's not really helpful. So what do you think is kind of missing or what could people be asking, especially if that's all they have access to as a general practitioner?

[00:09:03] Like, what could we be asking to go a little bit deeper to hopefully start to get answers? Modern medicine has mostly focused on expanding our lifespan. And we've done a fantastic job. You know, if we think about human history, we have historically lived till about age 40 for like more than 100,000 years. That's a really long time. Our lifespan was 40 and it ended.

[00:09:29] And then in the last 100 years, modern medicine did all this stuff that gave us an extra 30, 40, 50 years of life, you know, where we're living so much longer. But we haven't transitioned our lens to what are those years like? How are people feeling? You know, are we preserving health in a way that those years are worth it? And especially for women, you know, there's plenty of studies that show that although women live longer, we have a lower quality of life in our last 20, 30 years of life.

[00:09:57] So I think there's a few foundations to think about when you're thinking about your health when it comes to health span. And I think two big pillars are metabolic health. That's a big word. But all that means is what happens to food after you put it in your mouth? Is it used as fuel or is it stored as fat? And there's a bunch of labs that you could ask your doctor to order and we can talk about those that will give you insight into your metabolic health.

[00:10:26] And there are some simple changes you can make in your life to improve your metabolic health. And honestly, that is the biggest risk factor for almost all chronic diseases. Diabetes, high blood pressure, heart disease, cancer, dementia. So if we can get that metabolic health tuned up, not just to look good in a bikini, although that's a nice plus, it can really prevent a lot of those things that happen down the road. And I think that's highly tied in also to inflammation, which is another big topic.

[00:10:56] And there are also labs you can ask your doctor for to look at your level of inflammation in the body. And there are lifestyle tips and tricks that you can do to manage both your metabolic health and your level of inflammation that can really set a foundation for health. So going down that path, talking about metabolic health and levels of inflammation in the body, you know, we're really talking about optimizing someone's biology. You mentioned specific labs that can be run.

[00:11:24] I mean, what does this look like in practice, both on the medical side, some of those labs that you can maybe start looking at and also some of the lifestyle changes that people can look at making? The spectrum of metabolic health, you can be metabolically healthy and then the end point is uncontrolled diabetes. And some people are more genetically predisposed to that.

[00:11:43] And your doctor will usually run labs that look at your fasting blood sugar and probably look at a number called hemoglobin A1c, which is average of your blood sugar over three months. And those are important numbers. And of course, once you get in the pre-diabetic range and the diabetic range, the car is on fire and you've got to do something about it.

[00:12:04] But I think what's often missed is something called a fasting insulin level, because about 10 years before your hemoglobin A1c will go up, a lot of Americans will develop insulin resistance. So insulin is, if you hear one word, insulin is the most important hormone when it comes to metabolic health, because it locks your fat cells into your body and prevents any fat burning.

[00:12:33] So a person who's insulin resistant means that they will have to produce more insulin in order for it to do its job. And that basically locks you in a state of fat storage and your body can't get energy out of the food that you're eating. It's restoring everything as fat and fat causes inflammation and a whole bunch of other health problems.

[00:12:55] So fasting insulin can be really useful to know if you're on your way to becoming pre-diabetic and if you are metabolically healthy, in addition to that fasting blood sugar and the hemoglobin A1c. And if you find that your fasting insulin is high, there are some really helpful, easy interventions. So one thing is just walking after your big meals.

[00:13:23] So insulin brings all your blood sugar into cells. And it's basically the lock on the door. You have to use insulin. And what you want is your body to be as sensitive to that insulin as possible. But the only part of your body that can bring in blood sugar without using insulin is working muscle. So it's kind of a hack. If you can exercise for 10 minutes, even very lightly after a big meal, you're not depending on that insulin.

[00:13:50] And that alone can change somebody's metabolic landscape. You know, I think a lot of people get overwhelmed where they're like, oh, God, I'm going to have to cut out all carbs. I have to completely change my life. I can never eat anything I like again. But sometimes if you understand the problem and you can just do small targeted lifestyle changes to address that, it can go a long way.

[00:14:13] I mean, that is something I always think about as well, because we learned this in a podcast a long time ago talking to someone about just using that tool of walking, of getting a little bit of movement. And she brought up, like, even if you're just clearing the table for 10 minutes and doing the dishes and doing like you're not just going and sitting down, you know, after that big meal. And I think it's so important to it's something that I'm continuously trying to remind myself of as well.

[00:14:42] And, you know, and I feel like women go through, you know, these different hormonal stages, postpartum, paramenopause that feels like no matter what I do, I'm driving. I'm still holding on to that fact.

[00:15:00] So are there other like, is that an indication that we're not using our insulin the way that we're supposed to and that, you know, we are becoming insulin sensitive and what can we be doing and and what are other tools that we can use during these huge hormonal shifts that we're having? Yeah, hormonal transitions are can be so chaotic for women. And, you know, men have it easy.

[00:15:26] You guys have like one one main hormone, but we won't hold it against you. But women have this whole symphony of hormones and we go through a number of big hormonal transitions that can be pretty disruptive and that can disrupt our body composition. And the interplay between what we call our sex hormones like estrogen, progesterone, testosterone and insulin is pretty intricate.

[00:15:55] And insulin doesn't like it when our hormones are going up and down. Usually when they stabilize to either be low or high, insulin kind of gets over it, but it doesn't like it when it's going up and down. And that's what's happening postpartum. That's what's happening in perimenopause. And I think that there are a number of things that are sort of lifestyle anchors that make those time periods that can make those time periods a little bit easier.

[00:16:23] So, yes, making sure that you are remaining insulin sensitive. So the walking after meals, if you can do any sort of strength training and build some healthy muscle. So, you know, I'm sure you guys talk about this all the time, but muscle is really the currency of health. It's not just decorative. It's not just for lifting things.

[00:16:45] We know that muscles now secrete cytokines called myokines, which are really protective, which reduce inflammation, which help you be more insulin sensitive. So, and again, it doesn't have to be something extreme, but we have studies that women who have a higher amount of healthy lean muscle do so much better in perimenopause and do so much better postpartum. So, you know, just trying to hold on to that muscle is a big deal.

[00:17:17] Prioritizing sleep, of course, is really important. Sleep is something that often goes by the wayside and sometimes it's a necessity, especially in the postpartum period. You're not exactly getting quality sleep. But, you know, all our growth hormone is produced in our sleep, which is also related to all the other hormones and trying to protect sleep. And, you know, people often think about working on their diet.

[00:17:45] You know, I'm working on eating less of this or more of that. But, you know, we can also work on sleep and try to create boundaries around things in our lives that may be interfering with it. You know, making sure that we're in a dark room, that it's cool enough to sleep, that there's no lights disturbing you. And if it's possible to create that environment, that can actually go a long way.

[00:18:08] And there's a few supplements that I think are very useful, too, especially for women going through hormonal transitions that can just lower stress hormones at night and make sleep easier. So, like glycine, which is an amino acid, does this. Magnesium. I like L-theanine also. So, just kind of making sure that our body is resourced to try to get sleep when we're supposed to. For sure. I love that.

[00:18:38] And, I mean, you did bring up you're not going to hold it against men that they have it a little bit easier. And, man, I have especially watching Jen go through pregnancy twice, postpartum now. I mean, you're just over a year postpartum from our second. Massive, massive respect. A friend of mine, his wife just also had their first baby.

[00:19:01] And he put out a post saying, I don't think we worship women enough for what their bodies go through, especially to provide the youth for our next generation. And I completely agree because I somehow am still kind of running off my boyish teenage metabolism. And I'm going to take advantage of it as long as I can. But I feel like I have some sort of cheat code. Yeah. Eat a pint of ice cream every night. Don't change. Yeah.

[00:19:29] Don't tell everyone about my bad habits. Don't tell anyone about my bad habits. But I feel like women kind of go through this cascade where we're talking about going for walks. We're talking about strength training, which I feel like is becoming very popular and prevalent now, encouraging women to strength train. But we're also talking to a population who might be in their 40s, who might have little kids running around or teenagers that they're taking care of.

[00:19:56] They have brain fog, fatigue, the weight gain. And now we're telling them, oh, you just have to go out for a walk or you just have to strength train. And it's like this, you know, it's this catch 22 where, well, I don't have energy. Why would I strength train? That's just going to make me even more exhausted. Can you just like dig in a little more? Yes. And help make sense why it's so important to find the time. Yeah. And, you know, that's kind of where I fit in.

[00:20:23] And as a physician, obviously, I am prescribing. And I work with a lot of women who are depleted. And, you know, I prescribe a lot differently than I did when I worked in conventional medicine. And right now, when I do labs and I prescribe for a woman, I want to resource her to be able to build those good habits. So when I do labs, they're usually very comprehensive.

[00:20:52] I want to make sure that you have enough vitamins. You have enough micronutrients. There's so many women that I meet whose iron is too low. B12 is too low. Of course you don't have energy. You know, D is too low. And so we start building a foundation. And I think some women really benefit from bioidentical hormones and hormone support. And again, both hormones and other supplements, they're not going to do, they're not going to fix it completely.

[00:21:23] But I want you to have the energy to build the good habits. And sometimes I need to resource women a little bit more before they can really go out and do what they want to do. And, you know, I really feel like it's important for us to meet women where they're at.

[00:21:42] And also, you know, we're coming out of a time in history, you know, when I was young and previous generations of women, like we were really trained to eat less, move more. Stay depleted. Stay on a diet. You know what I mean? Where everything was sort of like, every message a woman got was about making herself smaller.

[00:22:06] So I meet a lot of women who are doing cardio five days a week and eating a thousand calories and like, they are so depleted. So it's more about like, I try to help women shift their mindset a little bit. We're like, what we're going to do is resource you. So, yeah, I want you to work on these good habits, but not because you need to like discipline yourself into shape, but because we now want you to receive.

[00:22:35] We want your body to receive good nutrition. We want your body to receive good sleep. And maybe we need to give you some biochemical support to have the energy to do just a little bit of strength training. But go slow, you know, take it easy. Do things that bring you joy. Don't kill yourself for some crazy ideal.

[00:22:55] You know, it's just like, I think women just need a little bit more nurturing and building up after these decades that we spent sort of giving women messages that we need to just cut them down. Which in a sense, it almost like, are we heading back to being smaller, being smaller, being smaller, you know, with the with the peptides and the support that we do have? Like we do have support.

[00:23:25] We do see some positive things from some of these peptides and the GLP ones. And we also are seeing women in our, you know, in the media now getting especially in media, but also just our friend groups and people around us continuing to get smaller and smaller and smaller.

[00:23:43] And some people like I know, you know, I could talk to my sister and her friends or like or not her friends, but people she knows are like, oh, I need to lose 10 pounds or I want to get snatched for a bikini. So I'm just going to go on for a minute. And it's becoming it almost feels like we're back to the smaller, still straight train, still eat your protein, but like be smaller.

[00:24:06] So how do we play and how are we dancing that role of like what are what are we looking at for health and longevity versus what are we looking at to be aesthetically pleasing to society again? Like, how do we how do we dance that line? You're asking me the hard questions. Skinny's back with the GLP one.

[00:24:29] No, but I think it's a great question, you know, and I think that like because it's been such a blockbuster, there's like always the response of things going, you know, going over the edge. And God, I would love every woman who's taking this to be on a microdose and to be looking more at body composition, you know, where I don't want anyone to lose muscle.

[00:24:53] I want you to be building muscle or gaining it and maybe reducing some of the harmful fat that can put you at risk for chronic illness. But yeah, I mean, I think that some of that mentality is is still there. And unfortunately, there are like the peptides, the GLP ones.

[00:25:16] There are absolutely wrong ways of using them, you know, and right now they've just sort of like come out and they're so available that like there are people who want to work with somebody who has a lot of expertise and want to do it the right way. And we can do that, you know, like we we don't let our patients lose muscle. We don't go on high doses. So you get super skinny, you know, and most women are really happy at the end of that.

[00:25:43] But but of course, with the accessibility now and like all the brainwashing that we've had and Hollywood and everything, you know, it's like with any trend or new thing that comes out, there's there's going to be there's going to be some bad effects. And and I think that like what I would like women to hear is just like these can be a tool that can be really powerful to make you healthier if they're used correctly.

[00:26:13] But if you're just getting skinny and losing muscle, you're really not doing yourself any favors. You know, every pound of lean muscle that you have burned six extra calories at rest, like doing nothing at all. So like the the women and men who get some GLP ones online, go up on the doses indiscriminately just to like get thin as quickly as possible, lose a ton of muscle.

[00:26:40] They go off of it and that everything comes back more. And even you get so hungry, you know, because you've lost that metabolic engine. So minus the muscle. Yeah. Yeah. Yeah. So so, you know, this is the kind of the trial and error phase of all this, you know, we've made here we are in this world where this is so accessible that like, of course, there are going to be some people who do this. We're always looking for the easiest fix.

[00:27:07] And but I hope that over time we can frame this in this conversation of like, let's build healthier bodies and let's not harm ourselves with these drugs. A thousand percent. So how do we know when these drugs are appropriate for us and when they're not? Like, when is it that, OK, I'm I'm working on diet and exercise.

[00:27:30] How long should I be doing like working on my nutrition, working on my exercise before I start thinking about getting on a GLP one? Or should I automatically start thinking of getting on a GLP one in conjunction with that? Is there something that I want to look out for within my body that would be, you know, for someone more like prone to say, OK, maybe, you know, being on a GLP one would help you with this?

[00:27:56] Like, is there something that we're trying to target specifically for women or men who want to go on, you know, and use some of these drugs? Like what's most effective? Mm hmm. So if you are 150 pounds overweight and everyone in your family has gotten diabetes and heart attacks and has died in their 50s and 60s, you should get on this drug. You know, so that that is a case use and you're already diabetic.

[00:28:24] So that is that's that's that's a no brainer. The benefits outweigh the risks that will transfer your metabolic health. But that's not who we're talking about right now. You know, I think who we're talking about right now is maybe the woman who's in her 30s or 40s who's gained maybe 15 pounds and it's hard to shed. And there's a bunch of things that are making it hard to shed. So I think a good lab evaluation in those cases is helpful.

[00:28:53] Looking at looking at what your insulin is doing, knowing your fasting insulin, looking at what you're where your hormones are, just an understanding to see if if your hormones are balanced or not. Estrogen, testosterone and progesterone. Looking at your thyroid to make sure your thyroid is working well. Um, I also like to check something called a high sensitivity CRP.

[00:29:20] And that looks at the level of inflammation in your body. Because sometimes what you have is an inflammation issue that's locking you into fat gain rather than an insulin resistant issue. GLP-1s are fantastic for insulin resistance. And then doing either a DEXA scan or an in-body weight that looks at your body composition. So that, um, if your fat compartment is a little bit heavier than we want it to, we have real specific targets.

[00:29:50] And then for, for, for, for people in this category, if, if we are considering a GLP-1, then I would honestly recommend a micro dose as low as possible and fiercely protecting your muscle by eating enough protein and strength training while you're on it. I think that, you know, for the people who have a lot of food noise or overwhelming cravings, real insulin resistance, that can be really worth it. And you can make some real metabolic changes while you're on it.

[00:30:19] Um, but understanding that this will probably be a short-term process. And during this time when you're a little bit less hungry, um, you're going to build really good habits. And then you're going to back off of it slowly and maintain those habits and, um, kind of use this as just a way to help enhance your health. Yeah. And I think you're hitting the nail on the head with having guidance while we're going through this.

[00:30:47] I kind of brought up that for years and years and years, we were just waiting for the skinny pill, the magic pill. And I feel like so many people have found felt feel like they have found that. And like you mentioned right now, we are just in the age of accessibility when it comes to this.

[00:31:04] And I do hope that there is a time in the near future that we get to some more regulation where, especially for populations that it might not be medically indicated for. Right. You really need to be with someone working with somebody going through a plan like you're mentioning where it's focused more on body composition. Yeah. And then when they feel the changes in their body, the aesthetics will come along with it. They'll feel the energy gain. They'll feel stronger.

[00:31:33] And also they might be happier as a bonus with what they see when they look in the mirror. And I don't, I never want to foo-foo people's aesthetic goals, but I also think you're pointing out something great, which is it needs to come along with fueling your body and making sure that you're setting up your body for success long-term.

[00:31:55] I also want to define a little bit because we've brought up GLP-1s and peptides and is a GLP-1 a peptide or are peptides different? How can they work in conjunction? And I know that you work with other peptides as well. So can you just explain the difference a little bit? Yes. So peptides are just a term that describes the chemical structure of a messenger inside your body.

[00:32:24] And it's just a short chain of amino acids. But we have thousands and thousands of peptides in our bodies that are constantly sending messages for our body to do one thing or another. And GLP-1s do fall into this class. What's different about peptides and other medications is that usually they mimic something that's already happening.

[00:32:45] So GLP-1s, they're GLP-1 agonists, which means that they help your body produce more of this hormone called GLP-1 that you're already producing in response to high protein, in response to other... You're already producing this. We're just producing a little bit more by giving you this medication. So there are other peptides that work on other targets.

[00:33:14] And these can also be really helpful for body recompositioning. And GLP-1s can be used long term, obviously. All other peptides, we usually use more as a short term agent and there's less of that rebound. So GLP-1s are certainly not the only option.

[00:33:34] And again, looking at labs, I think the second most important peptides that we have, especially when it comes to body composition, are growth hormone promoting peptides. And you can measure something called IGF-1 in your labs that tells you how much growth hormone your body is naturally producing. And for a lot of women, this goes down too. And that makes it really difficult to tap into fat stores and build muscle.

[00:34:03] So for some women, especially if there's just very little weight to lose and there's muscle to gain, we will work with peptides that allow your body to make more growth hormone on their own. So we're not giving you growth hormone. We're just giving you a peptide that tells your body to produce a little bit more. They're not like the GLP-1s in terms of like dramatic weight loss, but they absolutely help you gain muscle.

[00:34:31] And there are two that actually have FDA approval, which is samoralin and teslamoralin. So there's been extensive trials and safety data. And sometimes we pair those with a microdose of a GLP-1, especially in men who are just interested in body recompositioning or women with that goal of like 10, 15 pounds. So we're not leaning heavily on that GLP-1, but it can be part of a short-term plan to sort of help with body recompositioning.

[00:35:00] And they improve your energy, improve your sleep. So again, it's sort of like a short-term investment in your health and you're building that muscle and then you have a chance of maintaining it. That's just one example. There are other peptides that I use a lot that are anti-inflammatory.

[00:35:18] So again, we talked about, so very briefly, when I work with somebody who is having trouble losing weight, there are usually five barriers that I look at. The first is insulin resistance. The next is the growth hormone axis. And there's hormonal imbalance, inflammation, and just genetic issues. So we have peptides that can address a lot of those things.

[00:35:46] And when you actually get an understanding of why your body might maybe has locked in some extra fat tissue, then it's much easier to kind of develop a plan that's personal to someone. Now, when it comes to peptides, I feel like there's also been an explosion online, especially with influencers. Get my peptide stack, get this, get that.

[00:36:08] And I've also heard stories from other people of their sketchy experience with going to the ER because of certain peptides they were taking. And many of them are not FDA-approved. So how do we know what is safe and what is not? Because there's a lot of people who are also like, well, what about the antidotes? And like the people who are, so many people are saying they're getting help. So that must be safe.

[00:36:35] Like, how do we measure safety in this space? We're in the wild west of this right now. And I don't think anyone should be buying peptides off the internet. It's not safe. You just don't know. You don't know, you don't want to inject something into your body that you really don't know came from a trusted source. There was a big limitation on what compounding pharmacies could make for a long time. And those limitations are getting lifted.

[00:37:04] We're now, all the peptides that we use are created at and made by a compounding pharmacy, which has heavy oversight from multiple governing bodies. But the peptides you see on the internet, most of them are research chemicals.

[00:37:25] And, you know, there are probably some good companies out there that are testing for sterility, endotoxicity, purity. But there are also companies that have fake certificates of analysis, anything that's super cheap, you know, that you can produce dirty peptides very cheaply and they will, they can cause lifelong issues.

[00:37:49] So I think this, I often feel like this should go without saying, but don't inject something into your body that you've got off the internet. So where do we, where do we go to for peptides? Like, who are we talking to? Because a lot of doctors don't know about these. That's true. And like, and so what's safe, what's not? How do we know it or go? So we work with everybody. We work with people throughout the country and we can work with patients who,

[00:38:16] who are interested in peptides and we can obviously get them from a compounding pharmacy. And there are other physicians, you know, there's not that many, but, but there are doctors that you can look up who are working with peptide therapy that, I think that's, that's the safest way to go, you know? And, and I think eventually this will go away where we're not going to have influencers teaching people to inject things,

[00:38:44] which I think is a scary world, honestly. But, and the reason that they're injections is because they are these amino acids. And if you swallow them, your stomach would break them down and just digest them. They just don't survive the GI tract to do anything. That's why they have to be injected. There are some interesting developments coming where there's a, there are some companies that are making these oral strips that can actually just,

[00:39:12] they stick to your, to the roof of your mouth and they dissolve and absorb pretty quickly there. So hopefully that will be a safer method of delivery, but, and less risk of having these endotoxins and, you know, because you can have a fatal infection if, if you inject something under your skin, that's not pure and sterile. So yeah, this is not something to play around with. It's not anytime you're making, you're doing an injection.

[00:39:40] It's, this is a high risk situation and you want to do it with somebody who can keep you safe. And so with that, are there certain peptides that you commonly do recommend and certain ones that might be popular right now that you're like, I would stay away from that? So I think the ones that are BPC-157 is an anti-inflammatory peptide that can be really useful.

[00:40:06] You know, we kind of live in this chemical soup where we have these chemical exposures that, again, if we're looking at human history of being on earth for 200,000 years and our genes adapting to real food, suddenly there's this barrage of chemicals, both in our food and our environment that we've never seen. And so there's more inflammation in our bodies than, than we've ever seen. And that can show up as fatigue and weight gain and poor recovery from exercise.

[00:40:34] So I think that's a, that is a really good one and it can be very useful. Again, sourcing is, is important. We talked a little bit about the growth hormone promoting peptides. So, some morelin is one of the milder ones. It did get FDA approval for children with short stature, which just means that it's gone through more trials and we have more safety data on it.

[00:41:02] And I think that's really great for women in, in hormonal transitions to just put on a little bit more muscle, deepen sleep and maybe lose a little bit of fat. So those two are good. The one that I would stay away from, there's one called melanotan 2, which is called the Barbie doll peptide. And it, um, Just based on that name. I know, I know. It doesn't sound great. And it's called that because it makes you, um,

[00:41:31] lose weight, get tan and increases libido. So, um, you're tan, thin and horny. Um, and people are interested in that, but there's been some cases of, um, brain swelling and like really serious side effects. So we don't, we don't use it. Um, it's one that I would stay away from. Well, even with like the BP one, five, seven, is that? Sorry. I just, you know,

[00:42:01] been coming and seeing people that are saying there's a no, there's like very, very, very, very limited human studies. And so essentially when people are injecting them, they're, they're being the human study themselves. So like, what is the safety efficacy around something like that? Yeah. Yeah. So you're right. And I think BPC one, five, seven is interesting because, um, we have very little human data,

[00:42:29] but we have probably more clinical experience in terms of like using it with patients and reports of adverse effect. And again, it, it is something that's naturally produced that, um, in the studies we do have, there's just hasn't been any adverse effects reported in patients or, um, or in any of the trials. Um, Um,

[00:42:57] I think the one caveat is that it does promote the growth of new blood vessels. And if you are somebody who has a tumor or cancer, you don't want to grow new blood vessels to that. So when I, again, it's choosing the right patient and it's, it's always, I think when you use something like this, it's a risk benefit ratio. So for some people, like we talked about who should use a GLP one. And I gave you that example.

[00:43:23] If you're 150 pounds overweight and everyone in your family has diabetes or has died of a heart attack, then the risks absolutely are worth it. And the benefits outweigh the risks. And if you are somebody with multiple autoimmune conditions and are on six medications and are really overweight because of the level of inflammation in your body, and we have a discussion about what we know about BPC, what we don't know, what clinical experience we have,

[00:43:52] and we can make a decision together as a physician and a, and a patient do the benefits outweigh the risks for you. And, and we can come to that. And, and I have many clients for which it does, which are, it has sort of resolved arthritis pain, gotten them back to activity. You know, we've been able to build health habits. And again, these are always short term and they're not for everyone. And everyone has a different level of risk tolerance, but I think it's important to work with somebody who can,

[00:44:21] you could have a conversation about it. What do we know? What don't we know? What's an acceptable level of risk for you? And what can we expect to get out of this? I mean, that's the key there. And the main thing that I'm hearing from this is even with the deal or the peptides that have FDA approval or have a lot of research, it still needs to be a conversation. And it still should be something that you have someone guiding you through that risk benefit ratio. Exactly.

[00:44:48] That is the main message here that if you're talking with someone who is qualified, who works with these medications, that's going to be the best approach to make sure you're doing something that will support your health long-term. And I like how you kind of circled it back around. Like we've spent a lot of our conversation on this, but the whole goal is getting you back into this healthy way of living and getting you back to the activities that you may feel you're not able to do as much because of some of this fatigue, brain fog, weight gain, weight gain,

[00:45:18] inflammation. And that's the most important thing. Before we hopped on, we mentioned a little bit that we're noticing that there are some clinicians and researchers who, you know, are evidence-based and saying they're seeing more and more evidence that the changes that women's bodies go through, you know, specifically like bone loss, muscle loss, uh, that when they break down the research,

[00:45:45] you can't attribute what's happening in a woman's body when it comes to weight loss and bone loss to just the hormone changes that are happening in paramenopause, metabolic changes, hormonal and metabolic, metabolic changes that are happening in paramenopause. Um, I have some thoughts on this, but I would love to hear your thoughts on responding to an approach like that or a take like that. Yeah. And I think it's very nuanced and it's, and it's true. You know, I,

[00:46:14] I don't think nothing in biology and in nature is X equals Y, you know, it's, there's always a number of factors. I think that, um, lower estrogen levels do influence our, um, bone density, but so does your genetics, your diet, your strength training. So, um, the person who has, you know, been strength training is very active and, um,

[00:46:43] has been doing weight bearing exercise their whole life, enters their sixties, loses all their estrogen. They're good. You know, it didn't make a difference. And, um, the woman who's frail already and everyone in her family has, um, osteoporosis and she's never done weight bearing exercise in her life. Once she loses the protection of estrogen, I think that will make a difference. Um, estrogen is also an, an insulin sensitizer. I think biochemically we've,

[00:47:13] we've proven that, that you are more insulin sensitive when you have the protection of estrogen. Um, but again, it depends. You might be an insulin sensitive person. You might've been, remain insulin sensitive because of good habits and then your insulin, your estrogen drops and it doesn't make a big difference. But someone again, who's genetically more predisposed, um, maybe that loss of the protection of estrogen. Estrogen is protective for your brain, your bones,

[00:47:43] um, your metabolism. I think that's, I don't think that's up for debate. I think how much it affects you and what your habits are, what your life is like makes a big difference. I almost think that, and when I heard this, to me, it's an example of where it's only the black and white answers or takes that get a lot of attention on social media. So when you hear someone saying, you can't blame your hormones for this,

[00:48:11] it's all about lifestyle changes or it's all about this or that, your initial answer was nothing in biology is black and white. It's never 100% biology or 100% lifestyle. And to me, it was kind of like a chicken and egg conversation where I feel like if you got rational thinking people from both camps in a, in one room, they would agree with what you just said that sometimes the hormonal changes impact the lifestyle changes,

[00:48:38] or sometimes everything going on in someone's life impacts their lifestyle changes, which then impacts their hormones and their biology more. And you brought up a few examples. Everyone's different. You can look at a hundred different people and you have a hundred different answers when it comes to that question. So I appreciate the way you approach that. I know we often say, you know, especially when I was still in the ER, we talk about this, this patient didn't read the textbook and like,

[00:49:06] I've never met a patient who read the medical textbook and acted exactly like the disease is supposed to play out. You know what I mean? Like we're so unique. We're such a unique organism with so many inputs that, you know, I think we have to do the best for our particular history and our lifestyles. Which is so important because I think like, I had a really good friend who, when this came out, she was like sending me the posts and like,

[00:49:35] but this isn't like, she's in her forties and she's like, but I've gained so much weight and I'm lifting heavier than I ever have before. And this, like nothing has changed and she doesn't have kids. And like, it's not like any of these other factors that most people would complain of. And yet she's having huge metabolic changes. So she's like, well, something has to also be happening. So it's like, it could be so dismissive of women as well. When some of this research becomes out,

[00:50:01] that's just so black and white rather than taking into a bigger picture. So I appreciate like the approach that you take and the fact that you allow a place for women to get that expert testing, that expert guidance that is really needed in this space. And so where could people go and learn and work with you if they really want to dive in more? Yeah.

[00:50:27] So our website is thegeyerpractice.com. It's spelled G-A-J-E-R. And there's a button on there to book a free introductory call. And that's a great place to start. We don't want to waste anybody's time. We can answer whether it would make sense for you to work with us on that call. We are also on Instagram at thegeyerpractice. I try to look at the DMs and answer questions there. So yeah,

[00:50:56] we welcome anybody who wants to chat. Dr. Geyer, thank you so much for taking the time to be with us. In the midst of your busy practice and all the people you work with and all the content you put out. We really appreciate your time and expertise. Thank you so much. Such an incredible conversation with Dr. Geyer. And if you're interested in learning more from her or even working from her, go to her website and book that personal consultation. There's no risk involved.

[00:51:24] She will be able to help you understand if working with them is right for you. I just love the way she nuances all these answers and understands that everyone deserves their own independent journey and their own unique approach to their health. We talk about strength training a lot in this podcast. If you're interested in starting to get into strength training, we have some incredible courses that are available. The Lifting for Longevity course, 30 Days of Strength and Mobility, or Strong Healthy Joints. If you go to the link in the show notes,

[00:51:52] that's gen.health backslash courses. You can check out those and see what the differences are in those programs. They are great ways to start introducing or progress your strength training. If you're looking at getting more of that in your life, you can bundle courses and save. Or as a podcast listener, use code OPTIMAL10 at checkout to get a special discount. And of course, we will see you next time on the Optimal Body Podcast. We'll see you next time on the Optimal Body Podcast.